Test your knowledge with this 20-item exam about Fundamentals of Nursing covering the topics of nursing process and critical thinking in nursing and soar high on your NCLEX exam.
Topics or concepts included in this exam are:
- Nursing Process
- Critical Thinking in Nursing
- Various questions about Fundamentals of Nursing
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- If you need more clarifications, please direct them to the comments section.
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NCLEX Exam: Fundamentals of Nursing 4 (20 Items)
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NCLEX Exam: Fundamentals of Nursing 4 (20 Items)
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1. Critical thinking and the nursing process have which of the following in common? Both:
A. Are important to use in nursing practice
B. Use an ordered series of steps
C. Are patient-specific processes
D. Were developed specifically for nursing
2. In which step of the nursing process does the nurse analyze data and identify client problems?
C. Planning outcomes
3. In which phase of the nursing process does the nurse decide whether her actions have successfully treated the client’s health problem?
C. Planning outcomes
4. What is the most basic reason that self-knowledge is important for nurses? Because it helps the nurse to:
A. Identify personal biases that may affect his thinking and actions
B. Identify the most effective interventions for a patient
C. Communicate more efficiently with colleagues, patients, and families
D. Learn and remember new procedures and techniques
5. Arrange the steps of the nursing process in the sequence in which they generally occur.
C. Planning outcomes
D. Planning interventions
A. E, B, A, D, C
B. A, B, C, D, E
C. A, E, C, D, B
D. D, A, B, E, C
6. How are critical thinking skills and critical thinking attitudes similar? Both are:
A. Influences on the nurse’s problem solving and decision making
B. Like feelings rather than cognitive activities
C. Cognitive activities rather than feelings
D. Applicable in all aspects of a person’s life
7. The nurse is preparing to admit a patient from the emergency department. The transferring nurse reports that the patient with chronic lung disease has a 30+ year history of tobacco use. The nurse used to smoke a pack of cigarettes a day at one time and worked very hard to quit smoking. She immediately thinks to herself, “I know I tend to feel negatively about people who use tobacco, especially when they have a serious lung condition; I figure if I can stop smoking, they should be able to. I must remember how physically and psychologically difficult that is, and be very careful not to let be judgmental of this patient.” This best illustrates:
A. Theoretical knowledge
C. Using reliable resources
D. Use of the nursing process
8. Which organization’s standards require that all patients be assessed specifically for pain?
A. American Nurses Association (ANA)
B. State nurse practice acts
C. National Council of State Boards of Nursing (NCSBN)
D. The Joint Commission
9. Which of the following is an example of data that should be validated?
A. The urinalysis report indicates there are white blood cells in the urine.
B. The client states she feels feverish; you measure the oral temperature at 98°F.
C. The client has clear breath sounds; you count a respiratory rate of 18.
D. The chest x-ray report indicates the client has pneumonia in the right lower lobe.
10. Which of the following is an example of appropriate behavior when conducting a client interview?
A. Recording all the information on the agency-approved form during the interview
B. Asking the client, “Why did you think it was necessary to seek health care at this time?”
C. Using precise medical terminology when asking the client questions
D. Sitting, facing the client in a chair at the client’s bedside, using active listening
11. The nurse wishes to identify nursing diagnoses for a patient. She can best do this by using a data collection form organized according to: Select all that apply.
A. A body systems model
B. A head-to-toe framework
C. Maslow’s hierarchy of needs
D. Gordon’s functional health patterns
12. The nurse is recording assessment data. She writes, “The patient seems worried about his surgery. Other than that, he had a good night.” Which errors did the nurse make? Select all that apply.
A. Used a vague generality
B. Did not use the patient’s exact words
C. Used a “waffle” word (e.g., appears)
D. Recorded an inference rather than a cue
13. A patient is admitted with shortness of breath, so the nurse immediately listens to his breath sounds. Which type of assessment is the nurse performing?
A. Ongoing assessment
B. Comprehensive physical assessment
C. Focused physical assessment
D. Psychosocial assessment
14. The nurse is assessing vital signs for a patient just admitted to the hospital. Ideally, and if there are no contraindications, how should the nurse position the patient for this portion of the admission assessment?
A. Sitting upright
B. Lying flat on the back with knees flexed
C. Lying flat on the back with arms and legs fully extended
D. Side-lying with the knees flexed
15. For all body systems except the abdomen, what is the preferred order for the nurse to perform the following examination techniques?
A. D, B, A, C
B. C, A, D, B
C. B, C, D, A
D. A, B, C, D
16. The nurse is assessing a patient admitted to the hospital with rectal bleeding. The patient had a hip replacement 2 weeks ago. Which position should the nurse avoid when examining this patient’s rectal area?
C. Dorsal recumbent
17. How should the nurse modify the examination for a 7-year-old child?
A. Ask the parents to leave the room before the examination.
B. Demonstrate equipment before using it.
C. Allow the child to help with the examination.
D. Perform invasive procedures (e.g., otoscopic) last.
18. The nurse must examine a patient who is weak and unable to sit unaided or to get out of bed. How should she position the patient to begin and perform most of the physical examination?
A. Dorsal recumbent
19. The nurse should use the diaphragm of the stethoscope to auscultate which of the following?
A. Heart murmurs
B. Jugular venous hums
C. Bowel sounds
D. Carotid bruits
20. The nurse calculates a body mass index (BMI) of 18 for a young adult woman who comes to the physician’s office for a college physical. This patient is considered:
Answers and Rationale
1. Answer: A. Are important to use in nursing practice
Nurses make many decisions: some require using the nursing process, whereas others are not client related but require critical thinking. The nursing process has specific steps; critical thinking does not. Neither is linear. Critical thinking applies to any discipline.
2. Answer: B. Diagnosis
In the assessment phase, the nurse gathers data from many sources for analysis in the diagnosis phase. In the diagnosis phase, the nurse identifies the client’s health status. In the planning outcomes phase, the nurse formulates goals and outcomes. In the evaluation phase, which occurs after implementing interventions, the nurse gathers data about the client’s responses to nursing care to determine whether client outcomes were met.
3. Answer: D. Evaluation
In the assessment phase, the nurse gathers data from many sources for analysis in the diagnosis phase. In the diagnosis phase, the nurse identifies the client’s health status. In the planning outcomes phase, the nurse and client decide on goals they want to achieve. In the intervention planning phase, the nurse identifies specific interventions to help achieve the identified goal. During the implementation phase, the nurse carries out the interventions or delegates them to other health care team members. During the evaluation phase, the nurse judges whether her actions have been successful in treating or preventing the identified client health problem.
4. Answer: A. Identify personal biases that may affect his thinking and actions
The most basic reason is that self-knowledge directly affects the nurse’s thinking and the actions he chooses. Indirectly, thinking is involved in identifying effective interventions, communicating, and learning procedures. However, because identifying personal biases affects all the other nursing actions, it is the most basic reason.
5. Answer: C. “A, E, C, D, B”
Logically, the steps are assessment, diagnosis, planning outcomes, planning interventions, and evaluation. Keep in mind that steps are not always performed in this order, depending on the patient’s needs, and that steps overlap.
6. Answer: A. Influences on the nurse’s problem solving and decision making
Cognitive skills are used in complex thinking processes, such as problem solving and decision making. Critical thinking attitudes determine how a person uses her cognitive skills. Critical thinking attitudes are traits of the mind, such as independent thinking, intellectual curiosity, intellectual humility, and fair-mindedness, to name a few. Critical thinking skills refer to the cognitive activities used in complex thinking processes. A few examples of these skills involve recognizing the need for more information, recognizing gaps in one’s own knowledge, and separating relevant from irrelevant data. Critical thinking, which consists of intellectual skills and attitudes, can be used in all aspects of life.
7. Answer: B. Self-knowledge
Personal knowledge is self-understanding—awareness of one’s beliefs, values, biases, and so on. That best describes the nurse’s awareness that her bias can affect her patient care. Theoretical knowledge consists of information, facts, principles, and theories in nursing and related disciplines; it consists of research findings and rationally constructed explanations of phenomena. Using reliable resources is a critical thinking skill. The nursing process is a problem-solving process consisting of the steps of assessing, diagnosing, planning outcomes, planning interventions, implementing, and evaluating. The nurse has not yet met this patient, so she could not have begun the nursing process.
8. Answer: D. The Joint Commission
The Joint Commission has developed assessment standards, including that all clients be assessed for pain. The ANA has developed standards for clinical practice, including those for assessment, but not specifically for pain. State nurse practice acts regulate nursing practice in individual states. The NCSBN asserts that the scope of nursing includes a comprehensive assessment but does not specifically include pain.
9. Answer: B. The client states she feels feverish; you measure the oral temperature at 98°F.
Validation should be done when subjective and objective data do not make sense. For instance, it is inconsistent data when the patient feels feverish and you obtain a normal temperature. The other distractors do not offer conflicting data. Validation is not usually necessary for laboratory test results.
10. Answer: D. Sitting, facing the client in a chair at the client’s bedside, using active listening
Active listening should be used during an interview. The nurse should face the patient, have relaxed posture, and keep eye contact. Asking “why” may make the client defensive. Note-taking interferes with eye contact. The client may not understand medical terminology or health care jargon.
11. Answers: C, D
Nursing models produce a holistic database that is useful in identifying nursing rather than medical diagnoses. Body systems and head-to-toe are not nursing models, and they are not holistic; they focus on identifying physiological needs or disease. Maslow’s hierarchy is not a nursing model, but it is holistic, so it is acceptable for identifying nursing diagnoses. Gordon’s functional health patterns are a nursing model.
12. Answer: A, C, D
The nurse recorded a vague generality: “he has had a good night.” The nurse did not use the patient’s exact words, but she did not quote the patient at all, so that is not one of her errors. The nurse used the “waffle” word, “seems” worried instead of documenting what the patient said or did to lead her to that conclusion. The nurse recorded these inferences: worried and had a good night.
13. Answer: C. Focused physical assessment
The nurse is performing a focused physical assessment, which is done to obtain data about an identified problem, in this case shortness of breath. An ongoing assessment is performed as needed, after the initial data are collected, preferably with each patient contact. A comprehensive physical assessment includes an interview and a complete examination of each body system. A psychosocial assessment examines both psychological and social factors affecting the patient. The nurse conducting a psychosocial assessment would gather information about stressors, lifestyle, emotional health, social influences, coping patterns, communication, and personal responses to health and illness, to name a few aspects.
14. Answer: A. Sitting upright
If the patient is able, the nurse should have the patient sit upright to obtain vital signs in order to allow the nurse to easily access the anterior and posterior chest for auscultation of heart and breath sounds. It allows for full lung expansion and is the preferred position for measuring blood pressure. Additionally, patients might be more comfortable and feel less vulnerable when sitting upright (rather than lying down on the back) and can have direct eye contact with the examiner. However, other positions can be suitable when the patient’s physical condition restricts the comfort or ability of the patient to sit upright.
15. Answer: B. “C, A, D, B”
Inspection begins immediately as the nurse meets the patient, as she observes the patient’s appearance and behavior. Observational data are not intrusive to the patient. When performing assessment techniques involving physical touch, the behavior, posture, demeanor, and responses might be altered. Palpation, percussion, and auscultation should be performed in that order, except when performing an abdominal assessment. During abdominal assessment, auscultation should be performed before palpation and percussion to prevent altering bowel sounds.
16. Answer: A. Sims’
Sims’ position is typically used to examine the rectal area. However, the position should be avoided if the patient has undergone hip replacement surgery The patient with a hip replacement can assume the supine, dorsal recumbent, or semi-Fowler’s positions without causing harm to the joint. Supine position is lying on the back facing upward. The patient in dorsal recumbent is on his back with knees flexed and soles of feet flat on the bed. In semi-Fowler’s position, the patient is supine with the head of the bed elevated and legs slightly elevated.
17. Answer: B. Demonstrate equipment before using it.
The nurse should modify his examination by demonstrating equipment before using it to examine a school-age child. The nurse should make sure parents are not present during the physical examination of an adolescent, but they usually help younger children feel more secure. The nurse should allow a preschooler to help with the examination when possible, but not usually a school-age child. Toddlers are often fearful of invasive procedures, so those should be performed last in this age group. It is best to perform invasive procedures last for all age groups; therefore, this does not represent a modification.
18. Answer: B. Semi-Fowler’s
If a patient is unable to sit up, the nurse should place him lying flat on his back, with the head of the bed elevated. Dorsal recumbent position is used for abdominal assessment if the patient has abdominal or pelvic pain. The patient in dorsal recumbent is on his back with knees flexed and soles of feet flat on the bed. Lithotomy position is used for female pelvic examination. It is similar to dorsal recumbent position, except that the patient’s legs are well separated and thighs are acutely flexed. Feet are usually placed in stirrups. Fold sheet or bath blanket crosswise over thighs and legs so that genital area is easily exposed. Keep patient covered as much as possible. The patient in Sim’s position is on left side with right knee flexed against abdomen and left knee slightly flexed. Left arm is behind body; right arm is placed comfortably. Sims’ position is used to examine the rectal area. In semi-Fowler’s position, the patient is supine with the head of the bed elevated and legs slightly elevated.
19. Answer: C. Bowel sounds
The bell of the stethoscope should be used to hear low-pitched sounds, such as murmurs, bruits, and jugular hums. The diaphragm should be used to hear high-pitched sounds that normally occur in the heart, lungs, and abdomen.
20. Answer: D. Underweight
For adults, BMI should range between 20 and 25; BMI less than 20 is considered underweight; BMI 25 to 29.9 is overweight; and BMI greater than 30 is considered obese.
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