Foundation Exam #5 Summer 2025 at Denver College of Nursing

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Free Foundation Exam #5 Summer 2025 at Denver College of Nursing Questions

1. A nurse is planning a community health class about herbal remedies for a group of older adults. Which information about herbal remedies should the nurse include in the class?
  • Herbal supplements can be taken in larger quantities than pharmacological medications.
  • Herbal remedies are always safe and can be used without worries.
  • Herbal supplements can cause serious herbal-drug interactions with prescribed medications.
  • All herbal supplements are approved by the FDA and can be used regularly.

Explanation

Many herbal supplements can interact with prescription or over-the-counter medications, altering their effectiveness or causing harmful side effects. For example, St. John’s Wort can reduce the effectiveness of antidepressants and oral contraceptives, while Ginkgo biloba can increase bleeding risk when taken with anticoagulants. Older adults are especially vulnerable due to polypharmacy. Nurses should emphasize discussing all supplements with healthcare providers before use.
2. A client's labs have just resulted in the EHR. The nurse notes which of the following laboratory values is an acidotic pH?
  • pH of 7.38
  • pH of 7.4
  • pH of 7.0
  • pH of 7.7

Explanation

The normal blood pH range is 7.35 to 7.45. A pH below 7.35 indicates acidosis, meaning there is an excess of hydrogen ions or a loss of bicarbonate, which can result from conditions such as respiratory failure, diabetic ketoacidosis, or renal dysfunction. A pH of 7.0 is significantly acidotic and can lead to impaired cellular function and cardiac instability if not corrected promptly.
3. The UAP has been tasked with collecting and charting the client’s overall output. Which of the following are within the scope of the UAP? Select all that apply. One, some, or all options may be correct.
  • Emesis
  • Diarrhea
  • Urine
  • Beverages consumed during breakfast
  • IV Fluids

Explanation

A. Emesis: Measuring and documenting vomit (emesis) output is within the UAP’s scope of practice, as it is a measurable bodily output. The nurse will later interpret and evaluate the significance of the findings. B. Diarrhea: UAPs can observe, measure, and document stool output (including diarrhea). They should report abnormal color, consistency, or frequency to the nurse. C. Urine: Recording urine output is a basic responsibility of the UAP. Accurate measurement is essential for monitoring hydration and kidney function.
4. During a dressing change, the client tells the nurse that he closes his eyes and thinks about waves coming up on the beach. He states this helps with pain and anxiety associated with dressing changes. The nurse recognizes this client is using which CAM practice?
  • Tai Chi
  • Reiki Therapy
  • Guided Imagery
  • Prayer

Explanation

Guided imagery is a complementary and alternative medicine (CAM) practice that uses mental visualization to promote relaxation and reduce pain or anxiety. By imagining soothing scenes, such as ocean waves or peaceful landscapes, the client can calm the mind, reduce stress responses, and lower pain perception. It is often used during medical procedures, wound care, or anxiety-provoking situations to enhance comfort.
5. A client’s labs have just resulted in the EHR. The nurse notes which of the following laboratory values is a basic pH?
  • pH of 7.6
  • pH of 7.2
  • pH of 7.35
  • pH of 7.3

Explanation

The normal blood pH range is 7.35 to 7.45. A pH greater than 7.45 indicates alkalosis (basic pH), while a pH below 7.35 indicates acidosis. Therefore, a pH of 7.6 reflects a basic or alkaline state, suggesting that the client may be experiencing metabolic or respiratory alkalosis. The nurse should assess for potential causes such as hyperventilation, excessive vomiting, or overuse of antacids.
6. A client in a LTC facility is preparing for bed. The nurse knows that which sleep/bedtime hygiene actions can be delegated to the UAP? Select all that apply. One, some, or all options may be correct.
  • Providing warm tea to the client after verifying their diet orders.
  • Assessing the client for side effects of a sleeping pill given by the nurse.
  • Helping the client into their pajamas.
  • Assisting the client to brush their teeth.
  • Turning on music for the client to listen to.

Explanation

C. Helping the client into their pajamas: This is an activity of daily living (ADL) that can safely be delegated to the UAP. It helps prepare the client physically for rest and promotes comfort before sleep. D. Assisting the client to brush their teeth: This is another basic care activity appropriate for delegation. Oral hygiene before bed supports comfort and health, promoting good sleep hygiene. E. Turning on music for the client to listen to: Providing relaxing background music as part of the bedtime routine is a non-invasive comfort measure that UAPs can assist with to promote relaxation and sleep.
7. During a morning assessment, the nurse notes agitation in the client. When asked, the client states that they woke up suddenly and was unable to move. The nurse knows that this is referred to as:
  • Congestive Heart Failure
  • Sleep Paralysis
  • Cataplexy
  • Narcolepsy

Explanation

Sleep paralysis occurs when a person wakes up or is about to fall asleep and is temporarily unable to move or speak. It happens when the brain awakens from REM sleep, but the body’s muscle atonia (paralysis during REM) persists briefly. This can cause significant fear or agitation, though it is typically harmless and resolves within seconds to minutes.
8. The nurse is caring for an adolescent who is complaining of difficulty falling asleep. Which intervention would be most appropriate?
  • Keep the client's door fully open all night.
  • Raise the head of the bed to a sitting position.
  • Get the client a bright night light.
  • Encourage the discontinuation of caffeinated soda and chocolate snacks at night.

Explanation

Caffeine is a stimulant that interferes with the ability to fall asleep and maintain restful sleep. Adolescents often consume caffeinated sodas, energy drinks, or chocolate, which can delay sleep onset. The nurse should educate the client to avoid caffeine several hours before bedtime to promote healthy sleep hygiene. This intervention directly addresses the cause of difficulty falling asleep.
9. A 59-year-old is scheduled for hernia repair surgery. During the preoperative evaluation, the client tells the nurse that they have taken Coumadin (warfarin) daily and took their last dose this morning. The nurse knows that which is the priority intervention?
  • Tell the client it's harmless and they can continue to take it.
  • Contact the surgeon and anesthesiologist performing the surgery.
  • Proceed with charting the Warfarin and add it to the client's medication reconciliation.
  • Ask why the client is taking that medication and for how long.

Explanation

Warfarin (Coumadin) is an anticoagulant that increases the risk of excessive bleeding during and after surgery. Taking it on the day of surgery is a critical safety concern. The nurse’s top priority is to immediately notify the surgeon and anesthesiologist so they can determine whether the surgery needs to be delayed or rescheduled, and to plan appropriate reversal or monitoring measures (e.g., checking INR, administering vitamin K).
10. When teaching a client, it would be ideal for the nurse to ensure the following for an optimal teaching environment: Select all that apply. One, some, or all options may be correct.
  • A well-lit space
  • An area free of distractions
  • In the cafeteria
  • Meeting at the nurse’s station to talk

Explanation

A. A well-lit space: A well-lit environment helps the client clearly see teaching materials, written instructions, and demonstrations. Proper lighting enhances concentration and prevents visual strain, allowing the client to engage fully in the teaching session. It is especially important for older adults or clients with impaired vision to ensure they can read handouts and observe procedures accurately. B. An area free of distractions: A quiet, private space minimizes interruptions and noise that can interfere with comprehension and retention. Teaching in a distraction-free area helps the client focus entirely on the information being shared, improving understanding and recall. It also promotes open communication, allowing the client to ask questions without embarrassment or external pressure.

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