NUR 320 Exam #4 Summer 2025
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Free NUR 320 Exam #4 Summer 2025 Questions
1. The nurse is assessing the way a client ambulates. Which aspects are the nurse assessing during ambulation? (Select all that apply. One, some, or all may be correct.)
- A. Risk for fall
- B. Body alignment
- C. Activity tolerance
- D. Gait and balance
- E. Skin turgor
Explanation
A. Risk for fall
While observing ambulation, the nurse evaluates whether the client demonstrates weakness, unsteady movements, or poor coordination—all indicators of increased fall risk. Identifying this risk is essential for preventing injury.
B. Body alignment
Proper body alignment ensures that the head, spine, and limbs are positioned to minimize strain and support balance. The nurse observes posture and symmetry to assess for musculoskeletal or neurological issues affecting movement.
C. Activity tolerance
The nurse assesses how well the client tolerates physical activity, noting signs of fatigue, shortness of breath, or changes in heart rate or color during ambulation. This determines the client’s ability to perform daily activities safely.
D. Gait and balance
The nurse observes gait (the style or pattern of walking) and balance (the client’s ability to maintain an upright posture while moving). This helps identify neuromuscular deficits or coordination problems.
While observing ambulation, the nurse evaluates whether the client demonstrates weakness, unsteady movements, or poor coordination—all indicators of increased fall risk. Identifying this risk is essential for preventing injury.
B. Body alignment
Proper body alignment ensures that the head, spine, and limbs are positioned to minimize strain and support balance. The nurse observes posture and symmetry to assess for musculoskeletal or neurological issues affecting movement.
C. Activity tolerance
The nurse assesses how well the client tolerates physical activity, noting signs of fatigue, shortness of breath, or changes in heart rate or color during ambulation. This determines the client’s ability to perform daily activities safely.
D. Gait and balance
The nurse observes gait (the style or pattern of walking) and balance (the client’s ability to maintain an upright posture while moving). This helps identify neuromuscular deficits or coordination problems.
2. What are the 5 stages of grief?
- A. Connecting
- B. Depression
- C. Aggression
- D. Denial
- E. Controlling
- F. Anger
- G. Distancing
- H. 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.
3. A nursing student is administering an IM influenza vaccine. The nurse preceptor knows to intervene when the nursing student makes which of the following statements?
- A. "I can give the IM injection 2 inches from the umbilicus."
- B. "I will utilize the Z-track method for all IM injections."
- C. "I will administer the IM injection at a 90 degree angle."
- D. "I will administer the vaccine in the client's deltoid because it is less than 1 mL in volume."
Explanation
The statement “I can give the IM injection 2 inches from the umbilicus” is incorrect because this site is appropriate for subcutaneous injections, not intramuscular (IM) injections. IM injections must be given into muscle tissue such as the deltoid, ventrogluteal, or vastus lateralis to ensure safe and effective medication absorption. Injecting near the umbilicus risks damaging abdominal structures and provides inadequate muscle depth for IM delivery.
4. A newly admitted client has constipation and has been ordered medication. The nurse knows that the order for "docusate sodium 100 mg bid" should be given how frequently?
- A. Only at bedtime
- B. Two times per day
- C. Once per day
- D. Every other day
Explanation
The abbreviation “bid” stands for the Latin term bis in die, which means “twice a day.” Therefore, the medication docusate sodium 100 mg should be administered two times per day, typically spaced about 12 hours apart (for example, once in the morning and once in the evening). This stool softener helps prevent constipation by increasing water absorption in the stool, making bowel movements easier.
5. A 22-year-old client was newly diagnosed with type 1 diabetes. The nurse will instruct the client to utilize the following methods to administer the subcutaneous insulin injection of 20 units NPH once daily.
- A. 50-unit syringe, 25-gauge, 5/8 inch needle, administered at a 90-degree angle
- B. 3 mL syringe, 18-gauge, 2-inch needle, administered at a 90-degree angle
- C. 50-unit syringe, 20-gauge, 1.5-inch needle, administered at a 45-degree angle
- D. 1 mL syringe, 25-gauge, 5/8 inch needle, administered at a 45-degree angle
Explanation
Insulin is administered subcutaneously using an insulin syringe specifically calibrated in units. For a 20-unit NPH dose, a 50-unit insulin syringe ensures accurate measurement. The recommended 25-gauge, 5/8 inch needle allows for comfortable subcutaneous delivery, and a 90-degree angle is appropriate for clients with adequate subcutaneous tissue. This technique ensures proper insulin absorption from the fatty tissue into the bloodstream for effective glucose control.
6. 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.
7. A physician prescribes 3000 mL of D5W to be administered over 24 hours. A nurse determines that how many milliliters per hour will be administered to the client? (Round to the nearest whole number. Include units in your answer.)
- A. 100 mL/hr
- B. 115 mL/hr
- C. 125 mL/hr
- D. 150 mL/hr
Explanation
Formula and Calculation:
mL per hour=Total volume (mL) ÷ Total time (hr)
mL per hour=3000÷24
mL per hour=125 mL/hr
Final Answer:
The nurse should set the IV pump to 125 mL/hr.
mL per hour=Total volume (mL) ÷ Total time (hr)
mL per hour=3000÷24
mL per hour=125 mL/hr
Final Answer:
The nurse should set the IV pump to 125 mL/hr.
8. A client is receiving palliative care for symptom management related to dyspnea and pain. A family member asks if the client is dying since the client is receiving palliative care. Which response of the nurse is most appropriate?
- A. Palliative care is focused on curing the client’s illness.
- B. Palliative care and hospice care are the same thing.
- C. Palliative care is focused on relieving symptoms of illness and treatment.
- D. Palliative care is only for clients with 6 months or less to live.
Explanation
Palliative care is a comprehensive, multidisciplinary approach designed to enhance quality of life for clients who are experiencing symptoms related to a serious illness. It focuses on relief of pain, dyspnea, fatigue, nausea, anxiety, and other distressing symptoms caused either by the illness itself or by treatments such as chemotherapy or surgery. Importantly, palliative care can be provided at any stage of a chronic or life-threatening illness—from the time of diagnosis through advanced disease—and can be delivered concurrently with curative or life-prolonging therapies.
The nurse’s response should clarify that palliative care does not necessarily mean the client is dying. Instead, it prioritizes comfort, dignity, and holistic well-being, supporting both the client and their family through symptom management, psychosocial care, and spiritual support.
The nurse’s response should clarify that palliative care does not necessarily mean the client is dying. Instead, it prioritizes comfort, dignity, and holistic well-being, supporting both the client and their family through symptom management, psychosocial care, and spiritual support.
9. A nurse on a busy step-down floor has finished the head-to-toe assessment on a client. The nurse is ready to perform medication administration and knows that documentation of medications happens when?
- A. You can delegate medication documentation if you are too busy.
- B. After the medication is administered.
- C. Whenever you get time to sit down and document.
- D. Within 2–4 hours of giving the medications.
Explanation
Medication documentation must occur immediately after administration to ensure accuracy, maintain patient safety, and comply with legal and institutional requirements. Recording medications before giving them is unsafe and unethical, while delaying documentation increases the risk of medication errors, duplication, or omissions. Accurate, timely documentation provides a clear record of care and supports continuity between providers, safeguarding both the nurse and the client.
10. A 14-year-old client was recently diagnosed with type 1 diabetes. The client is prescribed 10 units of regular insulin and 15 units of NPH insulin each morning. How should the nurse instruct this client to give themself the prescribed doses of insulin?
- A. "First draw up the NPH insulin; then draw up the regular insulin in the same syringe."
- B. "First draw up and administer the regular insulin, then draw up and administer the NPH insulin."
- C. "First draw up and administer the NPH insulin. Wait at least 15 minutes; then draw up and administer the regular insulin."
- D. "First draw up the regular insulin; then draw up the NPH insulin in the same syringe."
Explanation
When mixing insulins, regular (clear) insulin is always drawn up before NPH (cloudy) insulin to prevent contaminating the regular insulin vial with intermediate-acting insulin. The phrase “clear before cloudy” helps nurses and clients remember the correct sequence. This ensures accurate dosing and maintains insulin effectiveness. Both insulins can then be administered together in one injection, minimizing the number of injections needed.
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