PN Fundamentals Exam

Extract:

Question 1 of 5

A nurse is providing nonpharmacological interventions for a client who is experiencing pain. Which of the following actions should the nurse take?

A. Encourage the client to abstain from distracting activities. B. Ensure that the client's room is kept at a cool temperature. C. Play music in the client's room. D. Keep the client's room well lit.

Correct Answer: C

Rationale: Playing music distracts from pain, reduces anxiety, and promotes relaxation, a proven nonpharmacological method.
Choice A is incorrect as distractions help.
Choice B may aid comfort but not pain directly.
Choice D may not affect pain perception.

Question 2 of 5

A nurse is caring for a client who had an indwelling urinary catheter inserted 3 days ago. Which of the following actions should the nurse take?

A. Obtain urine from the drainage bag if a urinary specimen is required. B. Use a catheter securing device to hold the catheter in place. C. Position the drainage bag higher than the client's bladder. D. Change the catheter bag every 3 days and as needed.

Correct Answer: B

Rationale: A securing device prevents movement and trauma, reducing infection risk.
Choice A risks contamination; sterile sampling is preferred.
Choice C causes reflux, increasing infection risk.
Choice D isn’t routine unless indicated, to avoid infection.

Question 3 of 5

A nurse is assisting in the transfer of a client who has left-sided weakness from a bed to a chair. Which of the following actions should the nurse take?

A. Stand on the client's stronger side when moving the client into the chair. B. Pivot on the foot farthest from the bed when assisting the client into the chair. C. Flex hips and knees when assisting the client to a standing position. D. Raise the bed to waist level before moving the client.

Correct Answer: C

Rationale: Flexing hips and knees uses proper mechanics, protecting the nurse and stabilizing the client.
Choice A is incorrect; stand on the weaker side for support.
Choice B risks imbalance; pivot on the closer foot.
Choice D is incorrect; lower the bed for foot placement.

Question 4 of 5

A nurse is reinforcing teaching with a client about using guided imagery to manage chronic pain. Which of the following statements by the client indicates an understanding of this technique?

A. I'll use focused breathing to control my pain. B. I'll learn to notice the sensation of muscle tension. C. I'll think about my grandfather's farm to reduce pain. D. I'll listen to my favorite music to take my mind off the pain.

Correct Answer: C

Rationale: Thinking about a farm uses visualization, a core of guided imagery, to reduce pain perception.
Choice A is breathing, not imagery.
Choice B is progressive relaxation.
Choice D is distraction via music, not imagery.

Question 5 of 5

A nurse is checking for the proper placement of a feeding tube. Which of the following methods is the most reliable for verification of tube placement?

A. Verify the bilirubin level of the tube contents. B. Auscultate for air insufflation. C. Request a chest x-ray. D. Check the pH level of gastric contents.

Correct Answer: C

Rationale: A chest x-ray definitively confirms tube placement, the gold standard.
Choice A isn’t standard.
Choice B is unreliable due to inconsistent results.
Choice D is useful but less definitive due to variable factors.

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