75 Practice Questions with Answers & Rationales
Fundamentals of Nursing (Questions 1-15)
1. A nurse is reinforcing discharge teaching with a client who has a new diagnosis
of heart failure. Which statement by the c
...
75 Practice Questions with Answers & Rationales
Fundamentals of Nursing (Questions 1-15)
1. A nurse is reinforcing discharge teaching with a client who has a new diagnosis
of heart failure. Which statement by the client indicates a need for further
teaching?
A. "I will weigh myself every day and report a gain of 2 pounds in a day."
B. "I should limit my sodium intake to less than 2 grams per day."
C. "It's important to rest between activities to conserve my energy."
D. "If I feel short of breath, I will lie down flat with my feet elevated."
Answer: D. Rationale: Lying flat (supine) increases venous return to the heart, which can
worsen pulmonary congestion and shortness of breath in a client with heart failure. The
client should sit upright (orthopneic position) or in High Fowler's position to ease
breathing. The other statements are correct .
2. A nurse is caring for a client who is receiving a continuous IV infusion of normal
saline at 125 mL/hr. The nurse notes that the client's urine output has been 50 mL
over the last 4 hours. What action should the nurse take first?
A. Notify the healthcare provider immediately.
B. Assess the IV site for infiltration and patency.
C. Continue to monitor as this is within normal limits.
D. Increase the IV rate to 150 mL/hr.
Answer: B. *Rationale: Oliguria (50 mL/4 hrs = 12.5 mL/hr, normal is >30 mL/hr) can
indicate decreased renal perfusion or fluid volume deficit. Before notifying the provider,
the nurse should assess for correctable causes, such as a kinked, infiltrated, or
disconnected IV line to ensure the client is actually receiving the prescribed fluids .*
3. A nurse is reinforcing teaching with a client about collecting a clean catch urine
specimen. Which statement by the client indicates a correct understanding of the
procedure?
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