NUR 320 Foundations of Nursing Exam #4 Summer 2025
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Free NUR 320 Foundations of Nursing Exam #4 Summer 2025 Questions
1. What are the 5 stages of grief?
- Connecting
- Depression
- Aggression
- Denial
- Controlling
- Anger
- Distancing
- Bargaining
- I. Acceptance
Explanation
B. Depression
Depression is the fourth stage of grief, marked by profound sadness and withdrawal as the individual fully acknowledges the loss. It is a natural emotional response, not a clinical disorder, reflecting the pain of separation and the process of internal healing.
D. Denial
Denial is the first stage of grief. It acts as a protective buffer against overwhelming shock. During this phase, the person struggles to believe the loss is real, often expressing disbelief or avoidance as a coping mechanism.
F. Anger
Anger, the second stage, represents frustration and helplessness over the loss. The person may direct this anger at themselves, others, or even a higher power. It’s a necessary step that helps the individual release emotional tension and begin acceptance.
H. Bargaining
Bargaining, the third stage, involves attempts to negotiate for more time or change the outcome of the loss. Individuals may make promises or “what if” statements as they seek to regain control or find meaning in their suffering.
I. Acceptance
Acceptance is the fifth and final stage, characterized by peace and acknowledgment of reality. The individual is no longer resisting the truth of the loss but begins adapting, reorganizing life, and finding a way forward while cherishing memories.
Depression is the fourth stage of grief, marked by profound sadness and withdrawal as the individual fully acknowledges the loss. It is a natural emotional response, not a clinical disorder, reflecting the pain of separation and the process of internal healing.
D. Denial
Denial is the first stage of grief. It acts as a protective buffer against overwhelming shock. During this phase, the person struggles to believe the loss is real, often expressing disbelief or avoidance as a coping mechanism.
F. Anger
Anger, the second stage, represents frustration and helplessness over the loss. The person may direct this anger at themselves, others, or even a higher power. It’s a necessary step that helps the individual release emotional tension and begin acceptance.
H. Bargaining
Bargaining, the third stage, involves attempts to negotiate for more time or change the outcome of the loss. Individuals may make promises or “what if” statements as they seek to regain control or find meaning in their suffering.
I. Acceptance
Acceptance is the fifth and final stage, characterized by peace and acknowledgment of reality. The individual is no longer resisting the truth of the loss but begins adapting, reorganizing life, and finding a way forward while cherishing memories.
2. If a nurse is using the Braden Scale for a client, the nurse is utilizing the scale to determine:
- Risk for impaired nutrition
- Risk for falls
- Risk for aspiration
- Risk for skin breakdown
Explanation
The Braden Scale is a validated assessment tool used to determine a client’s risk for developing pressure injuries (skin breakdown). It evaluates six categories: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. Each category is scored from 1 to 4, with lower total scores indicating higher risk. Early identification using the Braden Scale enables the nurse to implement preventive measures such as repositioning, skin protection, and moisture control.
3.
The nurse is caring for a client and notes that this area is non-blanchable. How would the nurse describe the assessment?
- A This is normal for patients who are not turning every 2 hours
- B Unstageable pressure injury
- C Stage I pressure injury
- D Eschar
Explanation
A non-blanchable area typically indicates a Stage I pressure injury, which is characterized by intact skin with non-blanchable redness over a localized area, often corresponding to a bony prominence.
4. A nurse is following safety principles to reduce the risk of needlestick injury. Which actions will the nurse take? Select all that apply. One, some, or all options may be correct.
- Recap the needle after giving an injection.
- Use needleless devices whenever possible.
- Remove needle and dispose in sharps box.
- Never force needles into the sharps disposal.
- Use clearly marked sharps disposal containers.
Explanation
B. Use needleless devices whenever possible
Using needleless systems minimizes direct exposure to sharp instruments, significantly reducing the likelihood of needlestick injuries. Hospitals adopt these systems as part of universal precautions and OSHA safety standards.
D. Never force needles into the sharps disposal
Forcing needles into an overfilled or jammed sharps container increases the risk of accidental puncture. Nurses should replace containers when they are three-quarters full to maintain safety and compliance.
E. Use clearly marked sharps disposal containers
Properly labeled and puncture-resistant sharps containers ensure used needles are disposed of correctly and not mistaken for regular trash, preventing accidental injuries to healthcare workers and housekeeping staff.
Using needleless systems minimizes direct exposure to sharp instruments, significantly reducing the likelihood of needlestick injuries. Hospitals adopt these systems as part of universal precautions and OSHA safety standards.
D. Never force needles into the sharps disposal
Forcing needles into an overfilled or jammed sharps container increases the risk of accidental puncture. Nurses should replace containers when they are three-quarters full to maintain safety and compliance.
E. Use clearly marked sharps disposal containers
Properly labeled and puncture-resistant sharps containers ensure used needles are disposed of correctly and not mistaken for regular trash, preventing accidental injuries to healthcare workers and housekeeping staff.
5. At time of death, which of the following tasks cannot be delegated to the assistive personnel (AP)?
- Changing the bedding and client's gown.
- Asking the family about organ and tissue donation.
- Helping to wash and prepare the body.
- Performing oral care on a client's dentures.
Explanation
Discussing or asking about organ and tissue donation is a highly sensitive and legally regulated process that must be handled by the registered nurse (RN) or a designated healthcare professional trained in organ procurement procedures. It requires clinical judgment, emotional sensitivity, and adherence to hospital policies and state laws. This conversation involves ethical considerations and should never be delegated to assistive personnel.
6. The client appears to be very close to death. The nurse would anticipate which of the following physical symptoms to be associated with impending death? Select all that apply. One, some, or all options may be correct.
- Requests for a full meal
- Restlessness
- Non-labored breathing
- Confusion
- Cheyne-Stokes respirations
- Cool, mottled skin of the extremities
Explanation
B. Restlessness
In the active dying phase, declining cerebral perfusion, hypoxia, and metabolic derangements (e.g., hypercapnia, acidosis) commonly produce restlessness or terminal agitation. Patients may fidget, pull at linens, or attempt to get out of bed. Addressing reversible contributors—urinary retention, pain, hypoxia, or unmanaged symptoms—while providing calm reassurance and minimizing environmental stimuli are key nursing actions.
D. Confusion
Fluctuations in consciousness and cognition arise from reduced oxygen delivery to the brain, systemic inflammation, and organ failure–related toxin accumulation (e.g., uremia). Confusion, disorientation, and altered sleep–wake cycles are typical. Nursing care emphasizes frequent reorientation, low-stimulation surroundings, and family presence. Evaluate for treatable causes (pain, hypoglycemia, urinary retention), but prioritize comfort and safety.
E. Cheyne-Stokes respirations
This waxing–waning pattern with cycles of apnea followed by progressively deeper respirations reflects dysregulation of the respiratory center as CO₂ responsiveness changes near end of life. Episodes may persist or lengthen as death approaches. Interventions focus on comfort: positioning for ease of breathing, gentle mouth care, and, when appropriate, low-dose opioids or anxiolytics for dyspnea-related distress.
F. Cool, mottled skin of the extremities
Peripheral vasoconstriction and falling cardiac output shunt blood to vital organs, causing coolness, cyanosis, and mottling (livedo reticularis) in feet, hands, and knees. Capillary refill often prolongs. Nursing care includes warm, light blankets (avoid overheating), frequent skin checks, gentle repositioning for comfort, and protecting fragile skin from shear and pressure.
In the active dying phase, declining cerebral perfusion, hypoxia, and metabolic derangements (e.g., hypercapnia, acidosis) commonly produce restlessness or terminal agitation. Patients may fidget, pull at linens, or attempt to get out of bed. Addressing reversible contributors—urinary retention, pain, hypoxia, or unmanaged symptoms—while providing calm reassurance and minimizing environmental stimuli are key nursing actions.
D. Confusion
Fluctuations in consciousness and cognition arise from reduced oxygen delivery to the brain, systemic inflammation, and organ failure–related toxin accumulation (e.g., uremia). Confusion, disorientation, and altered sleep–wake cycles are typical. Nursing care emphasizes frequent reorientation, low-stimulation surroundings, and family presence. Evaluate for treatable causes (pain, hypoglycemia, urinary retention), but prioritize comfort and safety.
E. Cheyne-Stokes respirations
This waxing–waning pattern with cycles of apnea followed by progressively deeper respirations reflects dysregulation of the respiratory center as CO₂ responsiveness changes near end of life. Episodes may persist or lengthen as death approaches. Interventions focus on comfort: positioning for ease of breathing, gentle mouth care, and, when appropriate, low-dose opioids or anxiolytics for dyspnea-related distress.
F. Cool, mottled skin of the extremities
Peripheral vasoconstriction and falling cardiac output shunt blood to vital organs, causing coolness, cyanosis, and mottling (livedo reticularis) in feet, hands, and knees. Capillary refill often prolongs. Nursing care includes warm, light blankets (avoid overheating), frequent skin checks, gentle repositioning for comfort, and protecting fragile skin from shear and pressure.
7. After surgery, the client with a closed abdominal wound reports a sudden "pop" after coughing. When the nurse examines the wound site, the sutures are open and the bowel can be seen protruding from the wound. Which of the following are appropriate nursing interventions? Select all that apply. One, some, or all options may be correct.
- Put the patient on NPO status.
- Apply a cold compress to the exposed bowel.
- Notify the surgical team immediately.
- Place dressing dampened with sterile water/saline over the area.
- Elevate the head of the bed 90 degrees.
Explanation
A. Put the patient on NPO status
The client should be kept nothing by mouth (NPO) in anticipation of emergency surgical repair. Eating or drinking could increase the risk of aspiration and delay surgery. This step prevents complications if anesthesia must be administered urgently.
C. Notify the surgical team immediately
This is a medical emergency known as evisceration, requiring immediate surgical intervention. The nurse must notify the surgeon and operating room team right away so that the client can be prepared for emergency surgery. Prompt communication helps prevent bowel necrosis and infection.
D. Place dressing dampened with sterile water/saline over the area
The nurse should cover the protruding bowel with sterile saline-moistened dressings to keep the exposed tissues moist and prevent drying, which could lead to tissue necrosis. Dry dressings or gauze must never be used because they can adhere to the organs and cause further damage when removed.
The client should be kept nothing by mouth (NPO) in anticipation of emergency surgical repair. Eating or drinking could increase the risk of aspiration and delay surgery. This step prevents complications if anesthesia must be administered urgently.
C. Notify the surgical team immediately
This is a medical emergency known as evisceration, requiring immediate surgical intervention. The nurse must notify the surgeon and operating room team right away so that the client can be prepared for emergency surgery. Prompt communication helps prevent bowel necrosis and infection.
D. Place dressing dampened with sterile water/saline over the area
The nurse should cover the protruding bowel with sterile saline-moistened dressings to keep the exposed tissues moist and prevent drying, which could lead to tissue necrosis. Dry dressings or gauze must never be used because they can adhere to the organs and cause further damage when removed.
8. A physician's prescription reads phenytoin (Dilantin) 0.2 g orally twice daily. The medication label states 100 mg capsules. A nurse prepares how many capsule(s) to administer one dose? Round to the nearest whole number and include units in your answer.
- 1 capsule
- 2 capsules
- 3 capsules
- 4 capsules
Explanation
Convert the prescribed dose from grams to milligrams: 0.2 g × 1000 mg/g = 200 mg per dose. Each capsule is 100 mg. Calculate the number of capsules: 200 mg ÷ 100 mg per capsule = 2 capsules. Rounded to the nearest whole number, the nurse should administer 2 capsules for one dose.
9. A nurse caring for an 88-year-old client on a medical/surgical floor knows that there are many factors that can affect skin breakdown and lead to pressure ulcer formation. Select which answers can help to prevent pressure ulcers. Select all that apply. One, some, or all options may be correct.
- Decreasing protein in a client's diet.
- Placing the client on a turning schedule every 2 hours.
- Keeping a client in bed as long as they want to be.
- Performing active ROM exercises even when a client is on bed rest.
- Massaging reddened areas of the skin to improve circulation.
Explanation
B. Placing the client on a turning schedule every 2 hours
Repositioning every two hours helps redistribute pressure over bony prominences, promoting blood flow and preventing tissue ischemia—the leading cause of pressure injuries. This is one of the most essential nursing interventions for immobile clients.
D. Performing active ROM exercises even when a client is on bed rest
Active or passive range of motion exercises stimulate circulation, maintain joint flexibility, and reduce muscle atrophy. Improved blood flow nourishes skin tissues, lowering the risk of pressure ulcer development in bedbound patients.
Repositioning every two hours helps redistribute pressure over bony prominences, promoting blood flow and preventing tissue ischemia—the leading cause of pressure injuries. This is one of the most essential nursing interventions for immobile clients.
D. Performing active ROM exercises even when a client is on bed rest
Active or passive range of motion exercises stimulate circulation, maintain joint flexibility, and reduce muscle atrophy. Improved blood flow nourishes skin tissues, lowering the risk of pressure ulcer development in bedbound patients.
10. A client has been on bed rest for 2 days. On assessment, the nurse identifies which of the following as a complication associated with immobility?
- Improved muscle tone
- A decrease in peristalsis
- Increased number of bowel movements
- Increased blood pressure
Explanation
Immobility causes a slowing of gastrointestinal motility, leading to decreased peristalsis. When clients remain inactive for extended periods, the lack of movement reduces stimulation of the intestinal muscles, resulting in constipation, fecal impaction, or even paralytic ileus in severe cases. This is a common and early complication of prolonged bed rest and emphasizes the importance of encouraging movement, hydration, and dietary fiber intake.
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