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. 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?
- "I can give the IM injection 2 inches from the umbilicus."
- "I will utilize the Z-track method for all IM injections."
- "I will administer the IM injection at a 90 degree angle."
- "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.
2. A 78-year-old client with arthritis in the left knee is utilizing a cane. The nurse has determined that the client is using the cane properly when
- The client adjusts the cane to keep the arm at 90 degrees.
- The client adjusts the cane 3 inches below the axilla.
- The client steps forward with their left leg with the cane on the left side of their body.
- The client steps forward with their left leg while using the cane on the right side of the body.
Explanation
When using a cane, the correct technique is to hold it on the strong (unaffected) side—in this case, the right side—and move the cane forward simultaneously with the weaker leg (left leg). This provides better balance, support, and weight distribution, reducing stress on the affected knee and preventing falls. The cane acts as a stabilizer, maintaining proper gait mechanics and promoting safe ambulation.
3. A 65-year-old client is recovering from surgery and is going to ambulate for the first time in 12 hours. A priority intervention prior to ambulation includes
- Obtaining an OT order and arranging for an occupational therapist to visit the home within 24 hours.
- Sitting the client up in bed slowly and dangling their feet at the bedside prior to ambulation.
- Acquiring a walker for the client and setting up physical therapy sessions prior to discharge.
- Asking the client to describe their exercise schedule and consulting the home health department.
Explanation
After prolonged bed rest, a client is at increased risk for orthostatic hypotension due to blood pooling in the lower extremities. The nurse should first sit the client up gradually and allow them to dangle their legs at the bedside for several minutes before ambulating. This intervention helps the cardiovascular system adjust, prevents dizziness or fainting, and promotes safe mobility.
4. After obtaining handoff communication from the previous shift's nurse, the nurse knows that which client is the PRIORITY?
- A 75-year-old client who can perform active ROM exercises independently and will be discharged today.
- A 24-year-old client who is grieving after receiving a cancer diagnosis.
- A 65-year-old client who has been admitted from a long-term care facility and has several wounds with slough.
- 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.
5. There are terms a nurse will need to know as they work in the clinical arena. When receiving shift report, the off-going nurse mentions that the client is having their blood glucose checked AC HS. The nurse knows that AC HS refers to:
- As needed for pain
- Two times a day
- Before meals and at bedtime
- Once in the morning
Explanation
The abbreviation AC HS stands for “ante cibum” (before meals) and “hora somni” (at bedtime). This means blood glucose should be checked before each meal and again at bedtime, allowing for accurate monitoring of glucose levels throughout the day and at night. This timing helps guide insulin administration, diet management, and ensures glycemic stability for clients with diabetes.
6. When reviewing the client's MAR, the nurse recognizes that the client has 14 medications ordered for 0900. The nurse knows that which term is the most appropriate when referencing this client's upcoming medication pass?
- Multidose
- Multilingual
- Medication reconciliation
- Polypharmacy
Explanation
Polypharmacy refers to the use of multiple medications by a single client, often five or more at one time. This situation increases the risk of drug interactions, side effects, and medication errors, especially in older adults or those with chronic conditions. A client with 14 medications scheduled for one time clearly demonstrates polypharmacy, requiring close monitoring and possible review of necessity and compatibility.
7. 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?
- "First draw up the NPH insulin; then draw up the regular insulin in the same syringe."
- "First draw up and administer the regular insulin, then draw up and administer the NPH insulin."
- "First draw up and administer the NPH insulin. Wait at least 15 minutes; then draw up and administer the regular insulin."
- "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.
8. Nurse Note
0700 am:
An 87-year-old client is admitted to the ER with weakness and fatigue. The client has a history of type 1 diabetes, smoking, and coronary artery disease. The client is wheelchair-bound and states that they have a nurse visit them at home 3 times per day to help them get out of bed and assist with their medication.
0800 am:
The nurse completes a complete head-to-toe assessment and notes the following during the assessment of the integument. Non-blanchable redness and partial thickness tissue loss to the left heel.
Vital Signs
HR-95
SpAO2-98% room air
Blood glucose- 150
Pain - 0/10 on a scale of 0-10
Labs
WBC-27,000
Albumin- 12 g/L
H/H- 13.0/38
Based on the nurse’s note and the table provided, which Action To Take, Potential Condition, and Parameter to Monitor are correctly matched for this client’s current findings?
0700 am:
An 87-year-old client is admitted to the ER with weakness and fatigue. The client has a history of type 1 diabetes, smoking, and coronary artery disease. The client is wheelchair-bound and states that they have a nurse visit them at home 3 times per day to help them get out of bed and assist with their medication.
0800 am:
The nurse completes a complete head-to-toe assessment and notes the following during the assessment of the integument. Non-blanchable redness and partial thickness tissue loss to the left heel.
Vital Signs
HR-95
SpAO2-98% room air
Blood glucose- 150
Pain - 0/10 on a scale of 0-10
Labs
WBC-27,000
Albumin- 12 g/L
H/H- 13.0/38
Based on the nurse’s note and the table provided, which Action To Take, Potential Condition, and Parameter to Monitor are correctly matched for this client’s current findings?
- Position the client to remove pressure off of bony extremity – Atelectasis – Blood Glucose
- Call the healthcare provider – Blood clot – Oxygen saturation
- Massage any reddened areas on the client’s body – Pressure injury – WBC count
- Position the client to remove pressure off of bony extremity – Pressure injury – WBC count
Explanation
The client’s left heel shows non-blanchable redness and partial-thickness tissue loss, consistent with a pressure injury. The appropriate nursing action is to remove pressure from bony prominences to prevent further tissue breakdown. Monitoring the WBC count is essential because an elevated value (27,000) indicates a potential infection associated with the wound. Relieving pressure and closely observing for infection are the top nursing priorities in this scenario.
9. 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?
- Only at bedtime
- Two times per day
- Once per day
- 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.
10. A client has been diagnosed with impaired physical mobility. Which SMART goal is correct for this client?
- The client will sit in the chair for each meal by end of day two of admission.
- The client will transfer to the chair with assist of one person.
- The nurse will reposition the client every hour while the client is awake.
- 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.
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