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. When caring for clients with pressure injuries, it is important to know what stage the wound is before wound care can begin. What two things prevent a pressure injury from being stageable and healing?
- A. Odor & Discharge
- B. Depth & Redness
- C. Size & Shape
- D. Eschar or Slough
Explanation
Eschar (dead, leathery tissue) and slough (yellow or white stringy tissue) prevent accurate staging and delay healing of a pressure injury. These tissues cover the wound bed, obscuring its depth and extent of damage. Until they are removed through debridement, the true stage cannot be determined, and healing cannot progress effectively because necrotic tissue impedes new cell growth and increases infection risk.
2. After obtaining handoff communication from the previous shift's nurse, the nurse knows that which client is the PRIORITY?
- A. A 75-year-old client who can perform active ROM exercises independently and will be discharged today.
- B. A 24-year-old client who is grieving after receiving a cancer diagnosis.
- C. A 65-year-old client who has been admitted from a long-term care facility and has several wounds with slough.
- D. A 55-year-old client who is newly admitted and is refusing to be turned every 2 hours.
Explanation
The priority client is the newly admitted client refusing to be turned, as this behavior increases the immediate risk for pressure injury, impaired skin integrity, and complications from immobility. Early intervention and patient education are crucial to prevent rapid skin breakdown, ensure safety, and establish trust and compliance with the care plan. Newly admitted clients also require close assessment for baseline condition and orientation to care expectations.
3. A client has recently arrived in the ED. Upon assessment, which observation by the nurse will indicate the client is at risk for pressure injury formation?
- A. The client is working daily with PT and OT.
- B. The client is eating 75–100% of their daily meals.
- C. The client is immobile and is currently bedbound.
- D. The client appears to have a capillary refill of less than 2 seconds.
Explanation
Immobility is one of the primary risk factors for pressure injury formation. When a client is bedbound, constant pressure on bony prominences reduces blood flow to tissues, leading to ischemia and skin breakdown. Without frequent repositioning, adequate nutrition, and pressure relief, tissue damage can progress to ulcer formation. Thus, a bedbound client is at the highest risk for developing pressure injuries.
4. The assistive personnel (AP) is caring for a dying client. Which action by the AP will cause the nurse to intervene?
- A. Keeping skin clean, dry, and moisturized.
- B. Elevating the head of the bed.
- C. Making the client eat.
- D. Assisting the client into a more comfortable position.
Explanation
Forcing or “making” a dying client eat is inappropriate and potentially harmful. As the body naturally begins to shut down, appetite and the ability to swallow decrease. Forcing food can cause choking, aspiration, or discomfort. End-of-life care focuses on comfort measures, respecting the client’s wishes, and relieving symptoms rather than promoting nutrition. The nurse should educate the AP that loss of appetite is a normal part of the dying process.
5. The nurse is discussing home medications with the client. The nurse knows that metabolism of medications occurs mostly in the:
- A. Stomach
- B. Heart
- C. Liver
- D. Pancreas
Explanation
The liver is the primary organ responsible for drug metabolism. It contains enzymes, particularly from the cytochrome P450 system, which chemically alter medications into inactive or more easily excretable forms. This process, known as biotransformation, helps prevent drug toxicity and maintains therapeutic levels. Impaired liver function (e.g., due to cirrhosis or hepatitis) can delay metabolism, leading to drug accumulation and adverse effects—making liver assessment vital in medication management.
6. Which of the following are considered HIGH RISK medications?
- A. Potassium, vancomycin, insulin, and furosemide.
- B. Opioid and non-opioid pain medications.
- C. Potassium, insulins, opioids, chemotherapeutics, and heparin.
- D. Antibiotics, antifungals, antianginals, and anticoagulants.
Explanation
High-risk medications are drugs that carry a higher risk of causing significant patient harm when used incorrectly. According to the Institute for Safe Medication Practices (ISMP), medications such as potassium, insulins, opioids, chemotherapeutic agents, and heparin require special handling, double-checks, and monitoring. Errors with these medications can result in severe hypoglycemia, bleeding, respiratory depression, or cardiac arrhythmias, making them critical to administer with precision and vigilance.
7. If a nurse is using the Braden Scale for a client, the nurse is utilizing the scale to determine:
- A. Risk for impaired nutrition
- B. Risk for falls
- C. Risk for aspiration
- D. 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.
8. A client has been diagnosed with impaired physical mobility. Which SMART goal is correct for this client?
- A. The client will sit in the chair for each meal by end of day two of admission.
- B. The client will transfer to the chair with assist of one person.
- C. The nurse will reposition the client every hour while the client is awake.
- D. The nurse will assist the client to ambulate in the hall by the second day.
Explanation
A SMART goal is Specific, Measurable, Achievable, Relevant, and Time-bound. Option A clearly identifies who (the client), what (sit in the chair for each meal), and when (by end of day two). This outcome is client-centered, measurable, realistic, and time-specific, reflecting progress toward improved mobility and independence. It aligns with nursing care goals to increase activity safely and gradually.
9. A client in critical condition is conscious, panicking, and questioning if they are going to survive. The MOST appropriate therapeutic response from the nurse would be:
- A. "I will call your physician NOW. There are medicines that can help you."
- B. "I understand you are anxious; I will stay right here by your side."
- C. "I promise you'll be fine. You're working with the best ER team in town."
- D. "You aren't going to die. I promise that everything is ok."
Explanation
This statement is therapeutic and supportive, acknowledging the client’s fear and providing emotional reassurance without giving false promises. By expressing understanding and a commitment to stay, the nurse conveys empathy, calm presence, and trust — essential for reducing anxiety in a panicking, critically ill client. This promotes psychological safety and emotional stability in a life-threatening situation.
10. 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.
- A. Decreasing protein in a client's diet.
- B. Placing the client on a turning schedule every 2 hours.
- C. Keeping a client in bed as long as they want to be.
- D. Performing active ROM exercises even when a client is on bed rest.
- E. 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.
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