Online Practice Test 44

Your Results for: "NCLEX® Review "

Print this page

Site Title: Kozier & Erb's Fundamentals of Nursing Book Title: Kozier & Erb's Fundamentals of Nursing Location on Site: Chapter 44 > NCLEX® Review Date/Time Submitted: July 29, 2012 at 1:41 PM (UTC/GMT)

Summary of Results 40% Correct of 10 Scored items: 4 Correct:  40% 6 Incorrect:  60% More information about scoring

1.		The nurse positions the immobilized client to maintain the ability for normal movement and stability. This is accomplished when the nurse: Your Answer: Balances the body off the center of gravity to prevent skin breakdown Correct Answer: Performs range of motion with every position change to keep joints flexible
		Objective: Describe four basic elements of normal movement. Rationale: When improperly positioned, joints flex into fixed positions and lose mobility. Properly aligned shoulders and hips fall into the same line of gravity. A properly balanced body is balanced at the center of gravity. Nursing Process: Implementation Client Need: Physiological Integrity Cognitive Level: Application Strategy: Use nursing knowledge and the process of elimination to make a selection.
2.		A teen in a full leg cast asks about preventing muscle mass loss in the cast. The best type of exercise the nurse can recommend is:  Your Answer: Isotonic Correct Answer: Isometric
		Objective: Compare the effects of exercise and immobility on body systems. Rationale: The client requires a form of exercise that does not require joint movement but does allow a change in muscle tension. Isotonic, isokinetic, and aerobic forms of exercises require active movement. Nursing Process: Planning Client Need: Physiological Integrity Cognitive Level: Application Strategy: Use nursing knowledge and the process of elimination to make a selection.
3.		On the fifth postoperative day after major abdominal surgery, the nurse evaluates a client for the effects of immobility. The nurse notes that the care plan was successful when the client states: Your Answer: "I'm still dizzy when I get up, but it is getting better." Correct Answer: "I am ready to eat something besides Jell-O and broth."
		Objective: Compare the effects of exercise and immobility on body systems. Rationale: The nurse is evaluating for signs that the client has suffered no effects of immobility. Answer 2 is an effect of immobility. Other findings are present, but not related to immobility. Nursing Process: Evaluation Client Need: Physiological Integrity Cognitive Level: Analysis Strategy: Use nursing knowledge and the process of elimination to make a selection.
4.		An employee health nurse teaches a body mechanics class. While demonstrating proper lifting techniques, the nurse says:  Your Answer: (blank)
5.		A position that puts an unconscious client at greatest risk for aspirating secretions is: Your Answer: Supine
		Objective: Use safe practices when positioning, moving, lifting, and ambulating clients. Rationale: Supine position puts client at greatest risk for aspirating secretions. Lateral, Sims', and prone positions allow secretions to drain from the mouth. Nursing Process: Planning Client Need: Physiological Integrity Cognitive Level: Application Strategy: Use nursing knowledge and the process of elimination to make a selection.
6.		Which of the following describes a client with a nursing diagnosis of Activity Intolerance III? Your Answer: Able to climb one flight of stairs slowly without stopping Correct Answer: Unable to climb one flight of stairs without stopping
		Objective: Unable to climb one flight of stairs without stopping is Develop nursing diagnoses and outcomes related to activity, exercise, and mobility problems. Rationale: Activity Intolerance III. Fatigued at rest is Level IV. Able to climb one flight of stairs slowly without stopping is Level II. Able to walk one city block without stopping is Level II. Nursing Process: Planning Client Need: Physiological Integrity Cognitive Level: Analysis Strategy: Use nursing knowledge and the process of elimination to make a selection.
7.		Two nurses plan to move a client with weakness into a wheelchair. As they prepare to make the transfer, one of the nurses correctly instructs the client to: Your Answer: Push up from the bed using her arms on the count of three
		Objective: Use safe practices when positioning, moving, lifting, and ambulating clients. Rationale: The client should push up from the bed using her arms on the count of three. The IV pole is unstable, and may roll away from the client. A client should face in the direction in which she is moving. The nurses' feet need to be in front of the client's. Nursing Process: Planning Client Need: Safe, Effective Care Environment Cognitive Level: Analysis Strategy: Use nursing knowledge and the process of elimination to make a selection.
8.		A nurse evaluating the performance of an unlicensed assistant corrects a client's position. Which client requires repositioning? Your Answer: A client in a Fowler's position, with the head of the bed raised 75 degrees, a large pillow placed under the head, and plantar flexion of the feet
		Objective: Identify factors influencing a person's body alignment and activity. Rationale: A client in a Fowler's position, with the head of the bed raised 75 degrees, a large pillow placed under the head, and plantar flexion of the feet, requires repositioning. Answers 2, 3, and 4 are positioned correctly. Nursing Process: Evaluation Client Need: Physiological Integrity Cognitive Level: Analysis Strategy: Use nursing knowledge and the process of elimination to make a selection.
9.		Which of the following techniques imposes the greatest stress on the nurse's back? Your Answer: Transferring clients in and out of bed
		Objective: Use safe practices when positioning, moving, lifting, and ambulating clients. Rationale: All of the answers may impose a stress on the nurse's back. Answer 4 imposes the greatest risk because of the potential for twisting and working in a small place. Nursing Process: Analysis Client Need: Safe, Effective Care Environment Cognitive Level: Application Strategy: Use nursing knowledge and the process of elimination to make a selection.
10.		A nurse is assessing a client's range of motion. An abnormality is detected when: Your Answer: The arm abducts 180 degrees laterally from the side of the body to the side and above the head Correct Answer: The thumb flexes 45 degrees toward the fifth finger
		Objective: Apply a variety of movement interventions and therapies to improve physical health, mobility, strength, balance, mood and cognition. Rationale: An abnormality is detected when the thumb flexes 45 degrees toward the fifth finger. Answers 1, 2, and 3 are not abnormalities. Nursing Process: Assessment Client Need: Physiologic Integrity Cognitive Level: Application Strategy: Use nursing knowledge and the process of elimination to make a selection.