Nursing Fundamentals Comprehensive Final Exam at Fox Valley Technical College
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Free Nursing Fundamentals Comprehensive Final Exam at Fox Valley Technical College Questions
You are caring for a client with a new diagnosis of obstructive sleep apnea. What would expect will be ordered for this client?
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A Oxygen delivered via a facemask
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B CPAP machine
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C A peak flow meter
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D Use of an incentive spirometer to strengthen the lungs
Explanation
The Correct Answer is: B. CPAP machine.
A CPAP machine (Continuous Positive Airway Pressure) is the primary treatment for obstructive sleep apnea. It keeps the airway open by delivering constant air pressure throughout the breathing cycle, preventing airway collapse during sleep. This reduces apneic episodes, improves oxygenation, decreases daytime fatigue, and lowers cardiovascular risks associated with untreated sleep apnea.
The nurse is providing care to a client with diarrhea. Appropriate interventions to include on the care plan for this condition would be: (Select all that apply – you will choose 6 of the 10 options)
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A Encourage fiber intake
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B Encourage sips of water or electrolyte drinks as tolerated
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C Encourage bland foods or the BRAT diet
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D Assess lung sounds daily
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E Assess bowel sounds every shift and prn
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F Only assess skin if client complains of pain
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G Assess perineal/rectal skin every shift and prn
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H Educate client to take antidiarrheal medications as soon as diarrhea occurs
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I Educate the client on appropriate hand hygiene
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J Monitor amount or number of stools and consistency of stool every shift
Explanation
The Correct Answers are:
B. Encourage sips of water or electrolyte drinks as tolerated
C. Encourage bland foods or the BRAT diet
E. Assess bowel sounds every shift and prn
G. Assess perineal/rectal skin every shift and prn
I. Educate the client on appropriate hand hygiene
J. Monitor amount or number of stools and consistency of stool every shift
B. Encourage sips of water or electrolyte drinks as tolerated
Diarrhea causes fluid and electrolyte loss, putting clients at risk for dehydration. Encouraging oral fluids such as water or electrolyte solutions helps replace lost volume, restore electrolyte balance, and maintain hydration. Frequent sipping is better tolerated than large amounts. This intervention is essential for preventing complications such as hypovolemia and orthostatic hypotension. C. Encourage bland foods or the BRAT diet
Bland foods (bananas, rice, applesauce, toast) are easier on the gastrointestinal system and can help firm stools. These foods are low in fiber, reduce bowel stimulation, and help decrease the frequency of diarrhea. This diet is recommended temporarily until stools begin to normalize.
E. Assess bowel sounds every shift and prn
Monitoring bowel sounds helps determine GI motility trends and the effectiveness of interventions. Hyperactive bowel sounds may indicate irritation, while the absence of bowel sounds could signal complications such as ileus. Regular assessment ensures early detection of worsening or improving conditions.
G. Assess perineal/rectal skin every shift and prn
Frequent diarrhea exposes skin to moisture and digestive enzymes, causing irritation and breakdown. Regular inspection allows early identification of redness, excoriation, or breakdown so prompt interventions can prevent infection or worsening skin damage.
I. Educate the client on appropriate hand hygiene
Diarrheal illnesses can spread easily, especially if caused by infectious agents. Teaching proper handwashing after toileting and before eating helps prevent transmission and protects both the client and others from infection. Hand hygiene is an essential infection-control measure.
J. Monitor amount or number of stools and consistency of stool every shift
Tracking stool frequency and characteristics helps evaluate hydration status, disease progression, and response to treatments. It also helps identify patterns, worsening symptoms, or development of complications such as blood or mucus in the stool.
While all of the following clinical manifestations are important to report to the primary health care provider when they occur, which would be the most important to report:
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A Anuria
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B Dysuria
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C Polyuria
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D Nocturia
Explanation
The Correct Answer is: A. Anuria.
Anuria—defined as producing less than 50 mL of urine in 24 hours—is a medical emergency. It may indicate acute kidney injury, severe dehydration, urinary obstruction, or shock. Immediate evaluation and intervention are required to prevent permanent kidney damage and life-threatening complications. Because it signals a failure of renal function, anuria is the most urgent condition to report.
Maintaining appropriate urinary output is important for appropriate urinary elimination and function of the urinary system. Which of the following hourly urine output amounts would cause the most concern related to the functioning of the urinary system and would be reported to the health care provider?
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A 15–25 ml
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B 50–60 ml
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C 75–85 ml
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D 90–100 ml
Explanation
The Correct Answer is: A. 15–25 ml.
An hourly urine output below 30 mL is a critical indicator of inadequate kidney perfusion and potential renal impairment. Output of 15–25 mL suggests that the kidneys are not filtering properly, which could be caused by dehydration, acute kidney injury, shock, or decreased cardiac output. This is an urgent finding that must be reported immediately to prevent further renal compromise and systemic complications.
You are caring for a client with a nursing diagnosis of Risk for Infection. Which of the following lab values would be most important to monitor related to infection? (Select all that apply – you will choose 3 of the 5 options)
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A White blood cell count and differential
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B Blood alcohol level
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C Cultures that were done
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D ESR and C-reactive protein
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E Serum albumin and blood urea nitrogen
Explanation
The Correct Answers are:
A. White blood cell count and differential
C. Cultures that were done
D. ESR and C-reactive protein
A. White blood cell count and differential
Monitoring the WBC count and differential is essential for detecting infection. Elevated WBCs or shifts in neutrophils, bands, or lymphocytes can indicate acute or chronic infection. A differential helps identify whether the source is bacterial, viral, or inflammatory. This lab value is one of the most sensitive and widely used indicators of infection risk and progression.
C. Cultures that were done
Cultures—such as blood, urine, sputum, or wound cultures—identify the exact organism causing infection. They guide antibiotic selection, confirm the presence of infection, and help determine whether treatment is effective. Cultures are directly relevant to diagnosing and managing infection, making them crucial to monitor for a client at risk.
D. ESR and C-reactive protein
ESR and CRP are markers of inflammation. They rise significantly during infection, especially bacterial infections, and help track severity and response to treatment. These markers are useful when symptoms are unclear or when infection is deep-seated or systemic, supporting early detection and ongoing monitoring.
The nurse enters a client's room with a portable computer station to assess the client' chart. The nurse does not log out while assisting a client to the bathroom. A visitor reads the client's chart and begins to question the nurse about the client information. This is an example of:
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A Providing health education to the visitor
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B Failure to maintain client confidentiality
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C Allowing defamation of character for the client to occur
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D Failure to educate the visitor
Explanation
The Correct Answer is: B. Failure to maintain client confidentiality.
Leaving a chart or electronic record viewable to unauthorized individuals violates the client’s right to privacy under HIPAA. The nurse must always log out or secure the computer before leaving it unattended. Allowing a visitor to view sensitive information compromises confidentiality and can lead to legal and ethical consequences. Protecting client information is a fundamental nursing responsibility.
An 89-year-old client is worried because she does not have a bowel movement every day. Which statement by the nurse reflects the best understanding of defecation patterns?
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A "A bowel movement each day is the normal pattern for most people. We will ask for a laxative order for you."
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B "The number of bowel movements per week varies greatly. For some people, it can be quite normal to have only two or three bowel movements per week."
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C "You just need to eat more fiber to stimulate daily bowel movements. Can I get you some prunes?"
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D "You shouldn't worry until you have gone at least five days without a bowel movement."
Explanation
The Correct Answer is: B. "The number of bowel movements per week varies greatly. For some people, it can be quite normal to have only two or three bowel movements per week."
This response provides reassurance and accurate education about normal bowel patterns. Defecation frequency varies widely among individuals, especially older adults, and having a bowel movement every day is not required for healthy function. This explanation reduces anxiety while preventing unnecessary laxative use. It also respects age-related changes in GI motility and promotes realistic expectations about normal bowel habits.
When providing education to the family of a client with sensory disorders, which would be the most correct information for the nurse to provide?
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A As your family member has problems hearing, the only real option is for you all to learn sign language
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B Not being able to see is not a huge problem and all clients will cope well with sudden blindness like your mother experienced
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C With lack of the ability to smell like your father has, you should make sure the home has functioning smoke detectors on all levels, as well as dating leftovers
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D As your grandfather has impaired sense of touch, you will want to make sure to face him while talking to him and allow him plenty of time to respond
Explanation
The Correct Answer is: C. With lack of the ability to smell like your father has, you should make sure the home has functioning smoke detectors on all levels, as well as dating leftovers.
Clients with anosmia (loss of smell) are at increased risk because they cannot detect smoke, gas leaks, or spoiled food. Educating families on ensuring working smoke detectors, carbon monoxide detectors, and careful monitoring of food safety is accurate, practical, and focused on real safety concerns. This advice prevents accidental harm and supports safe living conditions for someone with impaired smell.
A nurse is preparing a presentation on healthy nutrition for a group of adults. Which of the following would be correct to include: (Select all that apply – You will choose 4 of the 8 options)
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A "Carbohydrates should be your main source of energy as the body digests them more easily and quickly than proteins or lipids."
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B "You should try to eat about the same amount of carbohydrates, proteins and lipids in a day."
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C "If you are vegetarian, you will be getting plenty of complete proteins in your diet."
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D "Fiber helps prevent constipation, helps you feel full longer so prevents overeating and it can help prevent some condition like diverticulosis or diabetes ."
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E "Proteins help us move, build and repair body tissue, function in the immune system and act as enzymes."
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F "Protein is found in very few body tissues so you don't need to eat it every day."
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G "Lipids are needed in very limited amounts and all forms of them will cause heart disease so use care when eating them."
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H "Lipids are needed to absorb the fat-soluble vitamins, provide essential fatty acids, help us maintain our body temperature and help form some hormones."
Explanation
The Correct Answers are:
A. "Carbohydrates should be your main source of energy as the body digests them more easily and quickly than proteins or lipids."
D. "Fiber helps prevent constipation, helps you feel full longer so prevents overeating and it can help prevent some condition like diverticulosis or diabetes."
E. "Proteins help us move, build and repair body tissue, function in the immune system and act as enzymes."
H. "Lipids are needed to absorb the fat-soluble vitamins, provide essential fatty acids, help us maintain our body temperature and help form some hormones."
A. "Carbohydrates should be your main source of energy as the body digests them more easily and quickly than proteins or lipids."
Carbohydrates are the body’s preferred energy source because they break down quickly into glucose. They fuel the brain, muscles, and organs and are more efficiently used for energy than proteins or fats. A healthy diet typically includes carbohydrates as the major energy-providing nutrient, ideally from high-fiber, whole-food sources. D. "Fiber helps prevent constipation, helps you feel full longer so prevents overeating and it can help prevent some condition like diverticulosis or diabetes."
Fiber adds bulk to stool to prevent constipation, helps stabilize blood sugar, and promotes satiety, reducing overeating. It also lowers cholesterol and reduces the risk of diverticulosis. Adequate fiber is a key component of a healthy diet and supports both digestive and metabolic health.
E. "Proteins help us move, build and repair body tissue, function in the immune system and act as enzymes."
Proteins are essential structural and functional molecules. They repair tissues, build muscle, form antibodies, create enzymes and hormones, and support immune functioning. Without daily protein intake, muscle loss, poor healing, and immune compromise may occur.
H. "Lipids are needed to absorb the fat-soluble vitamins, provide essential fatty acids, help us maintain our body temperature and help form some hormones."
Lipids are crucial for absorbing vitamins A, D, E, and K. They provide essential fatty acids that the body cannot produce, help regulate temperature by providing insulation, and form the basis of many hormones. Lipids support brain function, cell structure, and overall health when consumed in proper amounts.
The parents of an adolescent client recovering from a crushed pelvis are concerned about the client’s lack of interest in music, television, or friends. What is the best response the nurse can make?
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A "I will inform his health care provider and see if we can get an antidepressant for your son."
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B "He is at a critical point of development where teens are often moody and being in the hospital will only make this worse."
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C "Your son had a major injury; and his immobility may be causing him to feel isolated and down."
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D "He is bored after 3 weeks in the hospital; I'll find some new activities for him to do."
Explanation
The Correct Answer is: C. "Your son had a major injury; and his immobility may be causing him to feel isolated and down."
This response acknowledges both the physical and emotional impact of the injury without dismissing or minimizing the parents’ concerns. Immobility, hospitalization, and pain often lead to feelings of isolation, sadness, or decreased interest in usual activities—especially in adolescents. This therapeutic response provides empathy, validates concerns, and opens the door for further assessment without making assumptions or offering inappropriate solutions.
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