Clinical Nursing Fundamental Exam

Correct Answers:

A: Teach the parents to reinforce their child's positive qualities.

C: Teach parents to ignore neutral behavior that is a matter of personal preference.

F: Teach parents to let their children practice skills and make it safe to fail.

Explanation of Correct Answers:

A: Teach the parents to reinforce their child's positive qualities.

Correct because positive reinforcement helps children recognize and appreciate their strengths.

Acknowledging positive qualities boosts self-worth and self-esteem.

C: Teach parents to ignore neutral behavior that is a matter of personal preference.

Correct because not every behavior requires intervention.

Allowing children to express themselves in harmless ways (e.g., clothing choices, hobbies) helps them develop autonomy and confidence.

F: Teach parents to let their children practice skills and make it safe to fail.

Correct because learning new skills and experiencing failure in a safe environment helps build resilience and self-esteem.

Encouraging children to try again after failure fosters a growth mindset and self-confidence.

Why the Other Options Are Incorrect:

B: Teach the parents to overlook occasional negative behavior.

Incorrect because negative behavior should not be ignored.

Instead of overlooking, parents should guide their children by setting clear expectations and using constructive discipline.

D: Teach parents to listen and "fix things" for their children.

Incorrect because self-esteem develops when children solve their own problems.

Parents should listen and support rather than fix everything, as problem-solving builds confidence and independence

E: Teach parents to describe the child's behavior and judge it.

Incorrect because judging a child’s behavior can lead to shame and insecurity.

Instead, parents should provide feedback without personal criticism, focusing on helping the child improve.

Final Summary:

​​​​​​​To build self-esteem, parents should reinforce positive qualities, allow self-expression, and create a safe space for learning and failure. Overlooking negative behavior, fixing problems for the child, or using judgmental language can hinder self-esteem development.

The correct answer is: Custard

Explanation of the Correct Answer:

A full liquid diet includes foods that are liquid or will turn into liquid at body temperature and provide more nutritional value than a clear liquid diet. Custard is a suitable option because it is a smooth, dairy-based food that meets the full liquid diet criteria while also being more satisfying than clear liquids.

Explanation of Incorrect Answers

Tea (Incorrect)

Tea is considered a clear liquid, not a full liquid, because it is transparent and does not contain any solid particles. It was already included in the client’s clear liquid diet, so it does not represent an advancement.

Gelatin (Incorrect)

​​​​​​​Gelatin (e.g., Jell-O) is also a clear liquid, as it becomes a transparent liquid at body temperature. It does not belong in a full liquid diet since it lacks the creamy consistency typical of full liquids.

Popsicle (Incorrect)

​​​​​​​A popsicle is considered part of a clear liquid diet because it melts into a clear liquid, similar to tea and gelatin. It does not provide the additional nutrients or thicker consistency expected in a full liquid diet.

Summary:

​​​​​​​A full liquid diet allows foods with a smooth, creamy consistency that provide more calories and protein than a clear liquid diet. Custard is the best option because it meets these criteria, while tea, gelatin, and popsicles are part of a clear liquid diet and do not signify an advancement.

The correct answer is: 4 oz skim milk.

Explanation for the correct answer:

4 oz skim milk:

When a client with type 1 diabetes mellitus reports symptoms of hypoglycemia (shakiness, palpitations), and a blood glucose level of 48 mg/dl is confirmed, immediate treatment with a fast-acting carbohydrate is required. Skim milk is an appropriate choice because it contains both lactose (a carbohydrate) and protein, which helps raise blood glucose levels in a steady, sustained manner. This provides both a quick rise in glucose and longer-lasting support.

Why the other options are wrong:

Graham crackers:

Graham crackers contain carbohydrates, but they are not as fast-acting as liquids like juice or milk. They are also not ideal because they require digestion, and a hypoglycemic episode should be managed with rapid glucose-raising foods.

1 tsp sugar:

Although 1 tsp of sugar can raise blood glucose levels, it is typically too small a quantity to quickly correct hypoglycemia in a client who is symptomatic (shaky, palpitations). A more substantial amount of carbohydrate is recommended.

4 oz diet soda:

Diet soda contains no sugar or carbohydrates, as it is artificially sweetened. It would not help in treating hypoglycemia, as the client needs a source of glucose to raise their blood sugar.

Summary:

For a client with type 1 diabetes mellitus and symptoms of hypoglycemia (shakiness, palpitations), the most effective treatment is a rapid-acting carbohydrate such as 4 oz of skim milk. This provides both immediate and sustained glucose support. The other options are either inadequate or not suitable for managing hypoglycemia in this scenario.

The correct answer is A: Better Clinical Outcomes, Increased Transparency and Efficiency, Empowered Individuals.

Explanation of the Correct Answer:

Meaningful Use in the Electronic Health Record (EHR) aims to improve healthcare delivery by ensuring effective and standardized use of digital health records. Compliance with Meaningful Use leads to:

Better Clinical Outcomes – EHRs enhance decision-making, reduce errors, and improve patient safety, leading to better overall patient care and outcomes.

Increased Transparency and Efficiency – Digital records allow for quicker access to patient information, streamlined workflows, and better communication among healthcare providers, reducing redundancies and errors.

Empowered Individuals – Patients have easier access to their health records, which enables them to take an active role in managing their health and improving shared decision-making with providers.

Explanation of Incorrect Answers:

Improved Population Health Outcomes, Increase Health Disparities, Engage Patients and Families – Incorrect

While improved population health outcomes and engaging patients and families are benefits of Meaningful Use, it does not increase health disparities—instead, it aims to reduce them by providing better access to healthcare data and improving patient-centered care.

More Robust Research Data on Health Systems, Improve Safety, Decrease Functionality – Incorrect

​​​​​​​More robust research data and improved safety are positive outcomes, but Meaningful Use does not decrease functionality. Instead, it aims to enhance EHR functionality by promoting better interoperability and usability.

Improved Population Health Outcomes, Complicate Care Coordination, Interoperability – Incorrect

​​​​​​​While improving population health outcomes and interoperability are key goals, Meaningful Use does not complicate care coordination; rather, it enhances it by ensuring better data sharing across healthcare systems.

Summary:

Meaningful Use compliance leads to better clinical outcomes, increased transparency and efficiency, and empowered individuals by improving patient care, reducing errors, and enhancing access to healthcare information.

Correct Answer C:  A 43-year-old patient who takes ginkgo biloba and an aspirin daily

Why Option C is Correct

Ginkgo biloba and aspirin both have blood-thinning properties, which increase the risk of excessive bleeding during and after surgery.

Aspirin is an antiplatelet agent that inhibits blood clotting, and ginkgo biloba is an herbal supplement known to have anticoagulant effects.

Many surgeons recommend stopping blood-thinning medications and supplements at least one to two weeks before surgery to reduce the risk of excessive bleeding during the procedure.

Since this patient is actively taking both ginkgo biloba and aspirin daily, the nurse should immediately inform the surgeon so that they can determine whether the surgery needs to be postponed or if adjustments should be made to the patient’s medication regimen.

Why the Other Options Are Incorrect

Option A: A 19-year-old patient who is a vegan

Incorrect because being a vegan does not inherently pose an immediate risk for surgery.

While vegans may have nutritional deficiencies (such as vitamin B12, iron, or protein), this alone is not a reason to postpone surgery unless a significant deficiency is present and affects healing or recovery.

The nurse may need to assess for potential deficiencies, but this is not an urgent concern requiring surgery postponement

Option B: An older adult patient who takes daily nutritional drinks

Incorrect because taking nutritional drinks does not interfere with surgery.

In fact, older adults often need additional nutrition to support healing, and this would not warrant postponing surgery unless severe malnutrition or another health condition is present.

The nurse should still assess the patient’s overall nutritional status, but there is no immediate danger that requires notifying the surgeon

Option D: An infant who is breastfeeding

Incorrect because breastfeeding itself does not require postponing surgery.

Infants do require special considerations for fasting before surgery, as prolonged fasting can cause dehydration and low blood sugar. However, breastfeeding is not a contraindication to surgery.

The nurse should follow hospital guidelines on preoperative feeding for infants, but this does not warrant postponing surgery unless the child has not adhered to fasting instructions.

Summary

The correct answer is Option C because the daily use of both ginkgo biloba and aspirin significantly increases the risk of excessive bleeding during surgery, which may require postponing the procedure or adjusting the patient’s medication regimen.

The other options are incorrect because:

Option A (vegan patient) does not pose an immediate surgical risk unless there is a severe deficiency.

Option B (older adult taking nutritional drinks) does not indicate a problem that would delay surgery.

Option D (breastfeeding infant) only requires preoperative feeding adjustments, not surgery postponement.

The nurse should always assess for factors that could interfere with safe surgery and recovery, especially medications and supplements that affect bleeding, anesthesia, and healing.

Correct Answer A: I can have fresh flowers brought in.

Explanation of the Correct Answer:

Patients with neutropenia (low neutrophil count) have a weakened immune system and are at high risk for infections. Fresh flowers, plants, and soil can carry bacteria, fungi, and mold, which can increase the risk of infection in immunocompromised patients.

Explanation of Incorrect Options:

B) I will avoid individuals who were recently vaccinated. – Correct Statement.

Live vaccines (e.g., MMR, varicella, nasal flu vaccine) can shed the virus and pose a risk to immunocompromised individuals.

Patients with neutropenia should avoid close contact with those recently vaccinated with live vaccines.

C) I should avoid soft cheese. – Correct Statement.

Soft cheeses (e.g., brie, feta, blue cheese) can contain Listeria, a bacterium that can cause severe infections in immunocompromised patients.

Patients with neutropenia should consume only pasteurized dairy products to reduce infection risk.

D) I can have visitors so long as they are healthy. – Correct Statement.

Visitors must be free of illness (cough, cold, fever, etc.) to prevent exposing the patient to infections.

Hand hygiene is crucial, and some facilities may require visitors to wear masks.

Summary:

The presence of fresh flowers or plants poses an infection risk for neutropenic patients due to the potential for bacterial and fungal contamination. Therefore, the patient requires additional education regarding this restriction.

Correct Answer:

Option a: The patient

Explanation of the Correct Answer:

A competent adult has the legal and ethical right to refuse medical treatment, even if that treatment is life-sustaining.

This patient has demonstrated capacity (she understands her decision and its consequences), is not influenced by depression, and has persistently refused interventions.

Autonomy is a fundamental principle in medical ethics, which means the patient’s decision must be respected.

Even though the provider and daughter disagree, they cannot override the patient’s wishes.

Explanation of Incorrect Answers:

Option b: The patient's daughter

Family members do not have the authority to override a competent adult’s decision.

If the patient were incapacitated, a designated healthcare proxy or next of kin might make decisions, but this does not apply here.

Option c: The patient's health care provider

A physician’s role is to provide medical advice and treatment options, not to force interventions against a competent patient’s wishes.

​​​​​​​If the provider cannot accept the decision, they may consult the ethics committee or transfer care to another provider.

Option d: The ethics consult team

An ethics committee provides guidance and recommendations, but it does not have the authority to make decisions for a competent patient.

​​​​​​​Their role would be to facilitate discussions and ensure ethical considerations are addressed.

Summary:

​​​​​​​The patient is the appropriate decision-maker because she is competent and has the right to refuse medical treatment, including life-sustaining interventions. Neither the daughter, healthcare provider, nor ethics committee has the authority to override her decision.

The correct answer is: Discuss pain management options.

Explanation for the correct answer:

Discuss pain management options:

The most supportive and effective approach for a client with cancer who is concerned about pain is to discuss available pain management options. Cancer pain can often be managed through various methods, including medications (opioids, NSAIDs), physical therapy, and complementary approaches (like acupuncture or massage). Open communication about pain management helps empower the client and alleviates anxiety, ensuring that their needs are addressed comprehensively.

Why the other options are wrong:

Instruct on why pain will continue throughout treatment:

This response can be distressing and may contribute to the client’s sense of hopelessness. Rather than focusing on why the pain might continue, it's more helpful to offer practical solutions for managing it.

Explain that every patient with cancer has pain:

This is an overgeneralization and may not be true for all patients. Not every cancer patient experiences pain, and focusing on this could make the client feel isolated or resigned to suffering, rather than offering hope for pain relief.

Review ways to reduce pain without the use of medication:

While non-medication options for pain relief (e.g., relaxation techniques, physical therapy) are important, medication is often a key part of pain management for cancer patients. Simply focusing on non-pharmacological methods may not adequately address the client's need for relief, especially if their pain is severe.

Summary:

When a client with cancer expresses concerns about pain, the most supportive approach is to discuss a range of pain management options, which can include both pharmacological and non-pharmacological treatments. This allows the client to feel informed, supported, and empowered to manage their pain effectively.

Correct Answe  C: Anticipating the scheduling of polysomnography to confirm OSA.

Explanation of the Correct Answer:

The child’s symptoms of snoring and labored breathing during sleep suggest the possibility of obstructive sleep apnea (OSA).

Polysomnography (sleep study) is the gold standard for diagnosing OSA. This test monitors brain activity, oxygen levels, heart rate, and breathing patterns during sleep.

OSA in children can result from enlarged tonsils and adenoids, obesity, or other airway abnormalities. If left untreated, it can lead to daytime sleepiness, learning difficulties, and cardiovascular complications.

Explanation of the Incorrect Answers:

Option a: Preparing the family for a diagnosis of insomnia and related treatments.

Insomnia refers to difficulty falling or staying asleep, not snoring and labored breathing.

The child’s symptoms do not align with insomnia since the concern here is abnormal breathing patterns rather than difficulty sleeping.

Option b: Preparing the family for a diagnosis of narcolepsy and related treatments.

Narcolepsy is a neurological disorder that causes excessive daytime sleepiness, sudden sleep attacks, and cataplexy (muscle weakness triggered by emotions).

​​​​​​​The child’s symptoms of snoring and labored breathing do not fit narcolepsy, making this answer incorrect.

Option d: No action would be taken, as this is a normal finding for hospitalized children.

Snoring and labored breathing are not normal in children and could indicate a serious sleep disorder such as OSA.

​​​​​​​Ignoring these symptoms could result in delayed diagnosis and complications such as poor oxygenation, cognitive impairments, and cardiovascular risks.

Summary:

​​​​​​​The child’s snoring and labored breathing suggest a potential diagnosis of obstructive sleep apnea (OSA), which requires polysomnography (sleep study) for confirmation. Other conditions such as insomnia or narcolepsy do not match the child’s symptoms, and ignoring the symptoms is not appropriate.