Colegio de Sta. Lourdes of Leyte Foundation, Inc.

COLLEGE OF NURSING
Tabontabon, Leyte
TEST DRILL IN FUNDAMENTALS OF NURSING
NAME
SCORE

DATE
_

DIRECTION: Write the letter of your choice on the space provided for in each item after you have
scrutinized the question impeccably. Admissible inks are black and blue alone and letters should be written
in their uppercase state. Erasures and superimpositions will most likely result to deduction of scores,
thereby, should be avoided.

1. A nurse enters a clients room and finds that the wastebasket is on fire. The nurse
immediately assists the client out of the room. The next nursing action would be to:
A. Call for help
C. Confine the fire by closing the door
B. Activate the fire alarm
D. Extinguish the fire
E.
2. A nurse is providing instructions to a client and the family regarding home care after a right
eye cataract removal. Which statement, if made by the client, would indicate effective
teaching?
A. I will not wear my glasses until my physician says its okay.
B. I will not sleep with my head elevated.
C. I will not sleep on my left side.
D. I will not sleep on my right side.
F.
3. A nurse assists a physician in performing liver biopsy. After the biopsy, the nurse plans to
place the client in which of the following positions?
A. Supine
B. Prone
C. A left side-lying position with a small pillow/folded towel under the puncture site
D. A right side-lying position with a small pillow/folded towel under the puncture site
G.
4. A nurse is administering a cleansing enema to a client with fecal impaction. Before
administering the enema, the nurse places the client in which of the following positions?
A. On the left side, with HOB elevated at
C. Left Sims position
45 deg
D. Right Sims position
B. On the right side, with HOB elevated
at 45 deg
E.
5. A nurse assists a physician with insertion of a Cantor tube in a client with bowel obstruction.
Following insertion of the tube, the nurse assists the client to which position initially?
A. Prone
C. Right sideD. Sims
B. Supine
lying
E.
6. A nurse is preparing to care for a client who has had supratentorial craniotomy. The nurse
positions the client to:
A. Prone
C. Semi-Fowlers
D. Dorsal
B. Supine
recumbent
E.
7. A nurse is preparing to communicate with an elderly client with hearing impairment. The most
appropriate nursing action is to:
A. Stand in front of the client
C. Obtain sign language interpreter
B. Exaggerate lip movements
D. Pantomime and write client notes
E.
8. The nurse is preparing a client for thoracocentesis. How should the client be positioned?
A. Supine with arms over head
B. Sims position
C. Prone without pillow
D. Sitting forward with arms supported on bedside table
F.
9. The nurse is preparing a client for paracentesis. Which activity should the nurse complete in
preparation for this test?
A. Have the client void before the procedure
B. Prepare the clients abdomen with betadine solution
C. Position the client supine
D. Make the client NPO 4 hours before the procedure

G.
10.A client undergoes cystoscopy with biopsy of the bladder. After the procedure, which
assessment is most appropriate for the nurse to make?
A. Assess patency of Foley catheter
C. Percuss bladder for distention
B. Assess urine for excessive bleeding
D. Obtain urine specimen for culture
E.
11.The physician decides to change a clients current dose of IM meperidine HCl (Demerol) to an
oral dosage. The current IM dose is 75 mg q4hrs prn. What dosage of oral meperidine will be
required to provide an equivalent analgesic dose?
A. 25-50 mg q4hrs
C. 125-140 mg q4hrs
B. 75-100 mg q4hrs
D. 150-300 mg q4hrs
E.
12.A client is scheduled for a creatinine clearance test. Which one of the following preparations is
appropriate for the nurse to make?
A. Instruct the client about the need to collect urine for 24 hours
B. Prepare to insert an indwelling catheter
C. Provide client with sterile urine collection container
D. Instruct client to force fluids to 3000ml/day
F.
13.Before administering morphine to a client, the nurse should assess the clients:
A. BP
B. RR
C. PR
D. T
E.
14.A client hasnt voided since before surgery, which was 8 hours ago. When assessing the
client, the nurse will:
A. Be unable to palpate the bladder
C. Palpate the bladder above the
B. Feel that the bladder is smooth
symphysis pubis
D. Palpate the bladder at the umbilicus
E.
15.When placing an indwelling urinary catheter in a female client, the nurse should advance the
catheter:
A. 2/5 cm
B. 6/15 cm
C. 8/20 cm
D. /1 cm
E.
16.Which member of the health care team is responsible for obtaining informed consent from the
client?
A. The primary nurse
C. The nurse working with the physician
B. The physician
D. The physicians assistant
E.
17.The nurse is obtaining a sterile urine specimen from a clients indwelling catheter. To prevent
infection, she should:
A. Aspirate urine from the tubing port, using sterile syringe and needle
B. Disconnect the catheter from the tubing an obtain urine
C. Open drainage bag and pour out some urine
D. Wear sterile gloves when obtaining specimen
F.
18.A nurse implements a teaching plan for a client scheduled for discharge. Which client
behavior best demonstrates effective teaching?
A. Exhibiting a positive change in behavior
B. Verbally repeating the instruction
C. Making statements indicating that the client understands
D. Exhibiting non-verbal signs such as nodding the head
G.
19.When performing abdominal assessment, the nurse follows:
A. Inspection, auscultation, percussion and palpation
B. Inspection, auscultation, palpation, percussion
C. Inspection, percussion, palpation, auscultation
D. Inspection, palpation, percussion, auscultation
H.
20.Which strategy can help make the nurse a more effective teacher?
A. Including the client in the discussion
D. Using loosely structured teaching
B. Using technical terms
sessions
C. Providing detailed explanations
E.
21.All of the following components may be a part of a clients medical record. Which one is the
major source of subjective data about the clients health status?
A. Health history
C. Lab test results
B. Physical findings
D. Radiologic findings
E.

22.When should the nurse check a client for rebound tenderness?

A. Near the beginning of the exam
C. Anytime during the exam
B. Before doing anything else
D. At the end of the exam
E.
23.The nurse is caring for a client who has suffered a severe CVA. During routine assessment, the
nurse notices Cheyne-Stokes respirations. These are:
A. Progressively deeper breaths followed by shallower breaths with apneic periods
B. Rapid, deep breaths with abrupt pauses between each breath
C. Rapid, deep breaths and irregular breathing without pauses
D. Shallow breaths with an increased RR
F.
24.The nurse is assessing a post-op client. Which of the following should the nurse document as
subjective data?
A. Vital signs
C. Clients description of pain
B. Lab test results
D. ECG waveforms
E.
25.A client, age 75, is admitted to the facility. Because of the clients age, the nurse should
modify the assessment by:
A. Shortening it
C. Addressing the client by the first name
B. Talking in a loud voice
D. Allowing extra time for the assessment
E.
26.A client complains of abdominal pain. To elicit as much info about the pain as possible, the
nurse should ask:
A. Are you having pain?
C. Is the pain sharp?
B. Is the pain constant?
D. What does the pain feel like?
E.
27.When percussing a clients chest, the nurse should identify which sound as a normal finding?
A. Hyperresona
B. Tympany
D. Dullness
nce
C. Resonance
E.
28.The nurse is caring for a client with history of falls. The first priority when caring for a client at
risk for falls is:
A. Placing the call light for easy access
B. Keeping the bed in the lowest position
C. Instructing client not to get out of bed without assistance
D. Keeping the bedpan available so that the client does not have to get out of bed
F.
29.A client who received general anesthesia returns from surgery. Postoperatively, which nursing
diagnosis takes highest priority for this client?
A. Pain r/t surgery
B. Deficient fluid volume r/t blood and fluid loss from surgery
C. Impaired physical mobility r/t surgery
D. Risk for aspiration r/t anesthesia
G.
30.When palpating a clients body to detect warmth, the nurse should use which part of the
hand?
A. Fingertips
C. Dorsal surface
B. Finger pads
D. Ulnar surface
E.
31.The nurse is evaluating a clients lung sounds. Which of the following breath sounds indicate
adequate ventilation when auscultated over lung fields?
A. Vascular
C. Bronchovesicular
B. Bronchial
D. Adventitious
E.
32.Which of the following is the single most reliable indicator of the existence and intensity of
acute pain?
A. Clients vital signs
D. Severity of the condition causing the
B. Clients self-report of pain
pain
C. Nurses assessment of the client
E.
33.When pain sensation has periods of remission and exacerbation, it is most appropriately
termed as:
A. Acute
C. Psychosoma
D. Intractable
B. Chronic
tic
E.
34.The nurse is preparing a teaching plan for a client recently diagnosed with Type 2 DM. what is
the first step in the process?

A. Establish goals
C. Assess the clients learning needs
B. Choose video materials and brochures
D. Set priorities of learning needs
E.
35.The nurse is teaching a group of patient-care attendants about infection control measures.
The nurse tells the group that the first line of intervention for preventing the spread of
microorganisms is:
A. Wearing gloves
C. Washing hands
B. Administering antibiotics
D. Assigning private rooms for clients
E.
36.The most important aspect of handwashing is:
A. Time
B. Soap
C. Water
D. Friction
E.
37.Local hot and cold applications transfer temperature to and from the body by:
A. Radiation
B. Evaporation
C. Convection
D. Conduction
E.
38.Which of the following lab test results is the most important indicator of malnutrition in a
client with wound?
A. Serum K+ level
C. Albumin level
B. Lymphocyte count
D. Differential count
E.
39.Which nutrient is most needed for wound healing?
A. CHO
B. Fat
C. CHON
D. Vitamins
E.
40.Vitamin C is essential to wound healing for:
A. Reduction of edema
C. Enhancement of CHON synthesis
B. Enhancement of O2 transport
D. Restoration of inflammatory process
E.
41.Which of the following is not a purpose of cleansing bath and skin care?
A. To reduce local inflammation
C. To provide exercise
B. To promote comfort
D. To stimulate circulation
E.
42.Which of the following positions of the client and the hospital bed is most appropriate when
doing bed bath?
A. Move client away from you and adjust bed in high position
B. Move client towards you and adjust bed in low position
C. Move client towards you and adjust bed in high position
D. Move client away from you and adjust bed to low position
F.
43.The temperature of water for tepid bath:
A. 92 to 94 deg F
C. 98 to 100 deg F
B. 95 to 97 deg F
D. 101 to 103 deg F
E.
44.The nurse is preparing to wash the clients arms and legs. This is best done with stroke:
A. From proximal to distal
C. From head to toe
B. From distal to proximal
D. From back to front
E.
45.The nurse may use one of many nursing theories to guide client care. What are the four key
concepts of most nursing theories?
A. Man, health, illness and health care
C. Man, environment, health and nursing
B. Health, illness, health restoration and
D. Health, environment, disease and
caring
treatment
E.
46.The goal of nursing according to Nightingale:
A. Develop interaction between nurse and client
B. Care for and help clients retain total self-care
C. Facilitate bodys reparative processes by manipulating clients environment
D. Reduce stress so that client can move easily through recovery process
F.
47.In interacting with patients, a nurse can be governed by Travelbees nursing model.
A. Interpersonal process is viewed as human-to-human relationship
B. Client continually changes and co-exists with the environment
C. Caring is central and unifying domain for nursing knowledge and practice
D. Nursing process is defined as dynamic interpersonal process between nurse, client and the
health care system
G.
48.Which range of applications does the nursing process have?
A. Broad
B. Distinct
C. Exact
D. Narrow

E.
49.A client is admitted to the health care facility with bowel obstruction secondary to colon
cancer. The nurse obtains a health history, measures vital signs and auscultates for bowel
sounds. Which step of the nursing process is she performing?
A. Planning
C. Evaluation
D. Implementati
B. Assessment
on
E.
50.What is an example of subjective data?
A. Color of wound drainage
D. Patients statement of I feel sick to my
B. Odor of breath
stomach
C. RR of 14 cpm
E.
51.A primary source of data collection in the assessment phase of the nursing process is the:
A. Chart
B. Patient
C. Doctor
D. Family
E.
52.A mother states, My son vomited 8 ounces of his formula this morning. This statement is an
example of:
A. Objective data from primary source
C. Subjective data from primary source
B. Objective data from secondary source
D. Subjective data from secondary source
E.
53.The nurse identifies a clients responses to actual or potential healt problems during:
A. Assessment
B. Analysis
C. Planning
D. Evaluation

E.
54.For the past 24 hours, a client with dry skin and dry mucous membranes has had a urine
output of 600 ml and a fluid intake of 800 ml. the clients urine is dark amber. These
assessment indicates which nursing diagnosis?
A. Impaired urinary elimination
B. Deficient fluid volume
C. Imbalanced nutrition: Less than body requirements
D. Excessive fluid volume
F.
55.During the planning step of the nursing process, the nurse:
A. Determines the clients goal achievement
B. Writes a statement about the clients health problem
C. Establishes short- and long-term goals
D. Gathers objective data
G.
56.Which of the following characteristics of the client goal in the care plan is correct?
A. Nurse-focused, flexible, measurable, realistic
B. Client-focused, flexible, realistic and measurable
C. Nurse-focused, time-limited, realistoic and measurable
D. Client-focused, time-limited, realistic and measurable
H.
57.A client has a nursing diagnosis of Risk for injury r/t adverse effects of potassium-wasting
diuretics. What is a correctly written client outsome for this diagnosis?
A. By discharge, the client correctly identifies three potassium-rich foods.
B. The client knows the importance of consuming potassium-rich foods daily.
C. Before discharge, the client knows which food sources are high in potassium.
D. The client understands all comlications of the disease process.
I.
58.During the planning phase of the nursing process, which of the following is the product
developed?
A. Nursing care plan
B. Nursing diagnoses
C. Nursing history
D. Nursing notes
J.
59.Which of the following times is ideal to begin discharge planning?
A. 24 hours after discharge
B. The day before the discharge
C. At time of admission
D. When the patient desires
K.
60.In the implementing phase of the nursing process, the nurse does which of the follosing
tasks?
A. Determines the patients health status
B. Identifies available resources
C. Measures goal achievement
D. Puts the NCP into action
L.