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PN 4006 Midterm Exam Questions & Answers, Exams of Nursing

Harvard UniversityNursing

PN 4006 Midterm Exam Questions & Answers

Typology: Exams

2024/2025

Available from 06/20/2025

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PN 4006 Midterm Exam Questions & Answers
1. The nurse is preparing to perform a physical examination on a client who
has cardiopulmonary disease. Knowing this about the client, the nurse is
alert for the presence of which of the following when checking the client's
nails? Select one:
a. Clubbing
b. Bands in nailbeds c.
Yellow discoloration
d. Splinter hemorrhages: A- clubbing
2. The nurse is auscultating the client's lungs and notes normal vesicular
sounds as being which of the following?
Select one:
a. Medium-pitched blowing sounds with inspiration equalling expiration
b. Loud, high-pitched, hollow sounds with expiration longer than
inspiration c. Soft, breezy, low-pitched sounds with longer inspiration
d. Sounds created by air moving through small airways: c. Soft,
breezy, low-pitched sounds with longer inspiration
3. During the physical examination, the nurse should use which part of the
hand to assess characteristics such as consistency, contour, and texture
in the client's glands?
Select one:
a. Dorsum of the hand
b. Pads of the fingers
c. Palmar surface of the hand
d. Fingertip grasp of the tissue: b. Pads of the fingers
4. If a low-pitched murmur is suspected with prior assessment, which of
the following is the best position for the client when the nurse auscultates
the apical site?
Select one:
a. Sitting up
b. Standing
c. Lying on the left side
d. Dorsal recumbent: c. Lying on the left side
5. Which of the following positions maximizes the nurse's ability to assess
the client's upper body for symmetry?
Select one:
a. Sitting b.
Supine c.
Prone
d. Dorsal recumbent: a. Sitting
1/20
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PN 4006 Midterm Exam Questions & Answers

  1. The nurse is preparing to perform a physical examination on a client who has cardiopulmonary disease. Knowing this about the client, the nurse is alert for the presence of which of the following when checking the client's nails? Select one: a. Clubbing b. Bands in nailbeds c. Yellow discoloration d. Splinter hemorrhages: A- clubbing
  2. The nurse is auscultating the client's lungs and notes normal vesicular sounds as being which of the following? Select one: a. Medium-pitched blowing sounds with inspiration equalling expiration b. Loud, high-pitched, hollow sounds with expiration longer than inspiration c. Soft, breezy, low-pitched sounds with longer inspiration d. Sounds created by air moving through small airways: c. Soft, breezy, low-pitched sounds with longer inspiration
  3. During the physical examination, the nurse should use which part of the hand to assess characteristics such as consistency, contour, and texture in the client's glands? Select one: a. Dorsum of the hand b. Pads of the fingers c. Palmar surface of the hand d. Fingertip grasp of the tissue: b. Pads of the fingers
  4. If a low-pitched murmur is suspected with prior assessment, which of the following is the best position for the client when the nurse auscultates the apical site? Select one: a. Sitting up b. Standing c. Lying on the left side d. Dorsal recumbent: c. Lying on the left side
  5. Which of the following positions maximizes the nurse's ability to assess the client's upper body for symmetry? Select one: a. Sitting b. Supine c. Prone d. Dorsal recumbent: a. Sitting
  1. The nurse is observing a new staff member work with the client. Of the following activities, which one has the greatest possibility of contributing to a nosocomial infection and requires correction? Select one: a. Washing hands before applying a dressing b. Taping a plastic bag to the bed rail for tissue disposal c. Placing a Foley catheter bag on the bed when transferring a client d. Using alcohol to cleanse the skin before starting an intravenous line: c. Placing a Foley catheter bag on the bed when transferring a client
  2. Which one of the following indicates that the nurse is using surgical aseptic technique? Select one: a. Inserting an intravenous catheter b. Placing soiled linen in moisture-resistant bags c. Disposing of syringes in puncture-proof containers d. Washing hands before changing a dressing: a. Inserting an intravenous catheter
  3. The client requires a sterile dressing change. Which of the following is an appropriate intervention for the nurse to implement in maintaining sterile asepsis? Select one: a. Put sterile gloves on before opening sterile packages. b. Check integrity of sterile packages prior to use. c. Place the cap of the sterile solution well within the sterile field. d. Place sterile items on the very edge of the sterile drape.: b. Check integrity of sterile packages prior to use.
  4. The nurse suspects that an older adult client may have pneumonia. Older adult clients may react differently to infectious processes, so the nurse is alert to atypical signs and symptoms, such as which one of the following? Select one: a. Hypotension b. Confusion c. Erythema d. Chills: b. Confusion
  5. The nurse recognizes the appropriate procedures for sterile asepsis. Of the following, which action is consistent with sterile asepsis? Select one: a. Clean forceps may be used to move items on the sterile field. b. Sterile fields may be prepared well in advance of the procedures.
  1. Which of the following statements is true for wounds that heal by primary intention? Select one: a. They will likely have minimal scarring. b. They will likely contain infected tissue. c. They will likely present with ragged edges. d. They will likely have portions of missing tissue.: a. They will likely have minimal scarring.
  2. The nurse recognizes that skin integrity can be compromised when skin is exposed to body fluids. The greatest risk exists for the client who has exposure to which one of the following fluids? Select one: a. Urine b. Purulent exudates c. Pancreatic fluids d. Serosanguineous drainage: c. Pancreatic fluids
  3. The client has rheumatoid arthritis, is prone to skin breakdown, and is also somewhat immobile because of arthritic discomfort. Which of the following interventions is the best one for this client's skin integrity? Select one: a. Having the client sit up in a chair for four-hour intervals b. Keeping the head of the bed in a high-Fowler's position to increase circula- tion c. Keeping a written schedule of turning and positioning d. Encouraging the client to perform pelvic muscle training exercises several times a day: c. Keeping a written schedule of turning and positioning
  4. Which of the following information about how smoking influences healing does the nurse include when planning a program on wound healing? Select one: a. Smoking suppresses protein synthesis. b. Smoking creates increased tissue fragility. c. Smoking depresses bone marrow function. d. Smoking reduces the amount of functional hemoglobin in the blood.: d. Smoking reduces the amount of functional hemoglobin in the blood.
  5. The client has a large, deep wound on the sacral region. The nurse correctly packs the wound by doing which one of the following? Select one: a. Filling two-thirds of the wound cavity b. Leaving saline-soaked folded gauze squares in place

c. Putting the dressing in very tightly d. Extending only to the surface of the wound: d. Extending only to the surface of the wound

  1. How should the nurse clean a wound? Select one: a. Go over the wound twice and discard that swab. b. Move from the outer region of the wound toward the centre. c. Clean wound from least contaminated to most contaminated area. d. Use an antiseptic solution followed by a normal saline rinse.: c. Clean wound from least contaminated to most contaminated area.
  2. The nurse observes thin, watery fluid draining from the left ear of a client who has sustained a head injury. How is this drainage described? Select one: a. Serous b. Purulent c. Cerebrospinal fluid d. Serosanguineous: a. Serous
  3. The nurse notes that the client's skin is reddened, with a small intact serum-filled blister. How should the nurse classify this stage of ulcer forma-tion? Select one: a. Stage I b. Stage II c. Stage III d. Stage IV: b. Stage II
  4. When turning a client, the nurse notices a reddened area on the coccyx. Which of the following skin care interventions should the nurse use on this area? Select one: a. Clean the area, dry it, and add a protective moisturizer. b. Apply a diluted hydrogen peroxide and water mixture, and use a heat lamp on the area. c. Soak the area in normal saline solution. d. Wash the area with an astringent and paint it with povidone-iodine (Beta-dine).: a. Clean the area, dry it, and add a protective moisturizer.
  5. The client is scheduled for a dressing change. When removing the adhe- sive tape used to secure the dressing, the nurse should lift the edge and hold the tape in which manner? Select one:

d. To decrease irritation from wound drainage: b. To cleanse the wound and remove bacteria

  1. Which of the following nursing entries is most complete in describing a client's wound? Select one: a. "Wound appears to be healing well. Dressing dry and intact." b. "Wound well approximated with minimal drainage." c. "Drainage size of quarter; wound pink, 4 × 4s applied." d. "Incisional edges approximated without redness or drainage; two 4 × 4s applied.": d. "Incisional edges approximated without redness or drainage; two 4 × 4s applied."
  2. Which of the following is the most common electrolyte imbalance? Select one: a. Hypokalemia b. Hyperkalemia c. Hyponatremia d. Hypernatremia: a. Hypokalemia
  3. The single best indicator of a client's fluid status is the nurse's assessment of which one of the following? Select one: a. The client's skin turgor b. The client's intake and output c. The client's serum electrolyte levels d. The client's daily body weight: d. The client's daily body weight
  4. The nurse anticipates that the client with a fluid volume excess will mani-fest which one of the following signs? Select one: a. Increased urine specific gravity b. Decreased body weight c. Increased blood pressure d. Decreased pulse strength: c. Increased blood pressure
  5. Out of all of the following clients, the nurse recognizes that which one is most at risk for a fluid volume deficit? Select one: a. A 6-month-old learning to drink from a cup b. A 12-year-old who is moderately active in 27°C weather c. A 42-year-old with severe diarrhea d. A 90-year-old with frequent headaches: c. A 42-year-old with severe diarrhea
  1. A client complains of a headache and chills during a blood transfusion. Which one of the following actions should the nurse take immediately? Select one: a. Check the vital signs. b. Stop the blood transfusion. c. Slow the rate of blood flow. d. Notify the physician and blood bank personnel.: b. Stop the blood transfusion.
  2. A client experiences a loss of intracellular fluid. The nurse anticipates that which of the following IV therapies will be used to replace this type of fluid loss? Select one: a. 0.45% normal saline (NS) b. 10% dextrose c. 5% dextrose in lactated Ringer's d. Dextrose 5% in 1/2 NS: a. 0.45% normal saline (NS)
  3. The nurse will be starting a new intravenous (IV) infusion and needs to select the site for the insertion. In selecting a site, the nurse should do which of the following? Select one: a. Start with the most distal site. b. Look for hard, cord-like veins. c. Use the dominant arm. d. Vigorously rub and tap the chosen vein.: a. Start with the most distal site.
  4. A rapid infusion of blood has been given to the client. The nurse assesses the client for which one of the following? Select one: a. Diaphoresis b. Anxiety c. Hypertension and tachycardia d. Nausea and vomiting: c. Hypertension and tachycardia
  5. An IV of 125 mL is to be infused over a one-hour period. A microdrip infusion set will be used. Which of the following is the nurse's calculation of the infusion rate? Select one: a. 32 gtt/min b. 60 gtt/min c. 125 gtt/min d. 250 gtt/min: c. 125 gtt/min

a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis: d. Respiratory alkalosis

  1. When a deficit of body fluid exists in the intravascular compartment, which of the following signs can be expected? Select one: a. Crackles b. Hypertension c. Neck vein distension d. An elevated hematocrit level: d. An elevated hematocrit level
  2. The physician orders 1000 mL of D5RL with 20 mmol KCl to run for eight hours. With an infusion set with a drop factor of 15 gtt/mL, which of the following will the nurse calculate the flow rate to be? Select one: a. 12 drops per minute b. 22 drops per minute c. 32 drops per minute d. 42 drops per minute: c. 32 drops per minute
  3. Which of the following is of great importance for the nurse to check before administering an IV solution with potassium that is prescribed for the client? Select one: a. Check for weakness. b. Assess renal function. c. Evaluate deep tendon reflexes. d. Initiate seizure precautions.: b. Assess renal function.
  4. A homeless client is brought into the emergency department with indi- cations of extremely poor nutrition. Arterial blood gases are assessed and the nurse anticipates that this client will demonstrate which of the following results? Select one: a. pH, 7.3; PaCO2, 38 mm Hg; HCO3, 19 mmol/L b. pH, 7.5; PaCO2, 34 mm Hg; HCO3, 20 mmol/L c. pH, 7.35; PaCO2, 35 mm Hg; HCO3, 24 mmol/L d. pH, 7.52; PaCO2, 48 mm Hg; HCO3, 28 mmol/L: a. pH, 7.3; PaCO2, 38 mm Hg; HCO3, 19 mmol/L
  5. A client has intravenous (IV) therapy for the administration of antibiotics and is stating that the IV site "hurts and is swollen." Which of the following information assessed on the client indicates the presence of phlebitis, as

opposed to infiltration? Select one: a. Intensity of the pain b. Warmth of integument surrounding the IV site c. Amount of subcutaneous edema d. Skin discoloration of a bruised nature: b. Warmth of integument surrounding the IV site

  1. Acute renal failure and a resulting metabolic acidosis develop in a client. The nurse recognizes that the respiratory system compensates through which of the following processes? Select one: a. Hypoventilation and increase of bicarbonate in the bloodstream b. Alternating periods of deep versus shallow breaths to maintain homeosta-sis of the serum pH c. Hyperventilation to decrease the serum carbon dioxide and thereby in-crease the pH d. Expansion of the lung tissues to their fullest, which increases the inspirato- ry reserve volumes to provide more oxygen to the tissues: c. Hyperventilation to decrease the serum carbon dioxide and thereby increase the pH
  2. A client has pneumonia. Which of the following evaluations does the nurse make about the effectiveness of the client's cough? Select one: a. The client has a frequent, dry cough. b. The client has decreased adventitious sounds on auscultation. c. The client is breathing with deeper inhalation. d. The client's oxygen saturation is improved:. b. The client has decreased adventitious sounds on auscultation.
  3. It is suspected that the client's oxygenation status is deteriorating. The nurse is aware that which abnormal assessment finding represents the most serious indication of the client's decreased oxygenation? Select one: a. Poor skin turgor b. Clubbing of the nails c. Central cyanosis d. Pursed-lip breathing: c. Central cyanosis
  4. The nurse is checking the client's overall oxygenation. In assessment of the presence of central cyanosis, which of the following areas will the nurse inspect? Select one:
  1. The client is admitted to the emergency department with a pneumothorax. Which of the following does the nurse anticipate the client will be experienc-ing? Select one: a. Dyspnea b. Eupnea c. Fremitus d. Orthopnea: a. Dyspnea
  2. The client has pneumonia in the left lobe. The nurse should encourage him to lie in which of the following positions? Select one: a. On the affected side b. With the unaffected lung down c. On either side d. Supine: b. With the unaffected lung down
  3. The electrical activity of the client's heart is being continuously monitored while he is on the coronary care unit. Suddenly, the nurse finds that the client is experiencing ventricular fibrillation. Which of the following actions should the nurse prepare to take? Select one: a. Administer atropine. b. Prepare for CPR and defibrillation. c. Prepare the client for surgical placement of a pacemaker. d. Instruct the client to perform the Valsalva manoeuvre.: b. Prepare for CPR and defibrillation.
  4. The nurse has reviewed information about the cardiovascular system be- fore caring for a client with heart disease. The nurse knows that which of the following statements is true concerning the physiology of the cardiovascular system? Select one: a. Stimulating the parasympathetic system would cause the heart rate to increase. b. When a person has heart muscle disease, the heart muscles stretch as far as is necessary to maintain function. c. The QRS interval on the electrocardiogram represents the electrical impuls-es passing through the ventricles. d. When stroke volume decreases, a resultant decrease in heart rate occurs.-: c. The QRS interval on the electrocardiogram represents the electrical impulses passing through the ventricles.
  1. On admitting a client, the nurse finds a history of myocardial ischemia. What is the most disconcerting dysrhythmia that electrocardiography can reveal for this client? Select one: a. Sinus bradycardia b. Sinus dysrhythmia c. Ventricular tachycardia d. Atrial fibrillation: c. Ventricular tachycardia
  2. The client with a chronic obstructive respiratory disease is receiving oxy-gen via a nasal cannula. The nurse plans to include which of the following interventions in the client's care? Select one: a. Assess nares for skin breakdown every six hours. b. Check patency of the cannula every two hours. c. Inspect the mouth every six hours. d. Check oxygen flow every 24 hours.: a. Assess nares for skin breakdown every six hours.
  3. The nurse is preparing to remove the skin staples from an older adult's incision. Which action should the nurse take to prevent a complication as a result of age and its effect on healing? Select one: a. Be prepared to use skin glue on the edges of the wound. b. Have Steri-Strips ready to use after the staples are removed. c. Increase the amount of protein in the patient's diet. d. Assess the skin edges before the patient is discharged.: b. Have Steri- Strips ready to use after the staples are removed.
  4. The nurse prepares to change the patient's dressing using sterile tech- nique. Which does the nurse implement to promote infection control? Select one: a. Scrubs the drain insertion site in a back-and-forth manner b. Cleans the incision from wound edges toward the center c. Removes the old dressing with clean gloves; inspects the wound d. Dons sterile gloves, removes the dressing, and opens sterile supplies: c. Removes the old dressing with clean gloves; inspects the wound
  5. The nurse prepares to remove the patient's sutures and staples. Which step should the nurse implement before proceeding with the removal? Select one: a. Assess the type of suture material used. b. Snip off both ends of the suture material.

a. Assess the wound for sinus tracts and tunneling. b. Maintain oxygenation with supplemental oxygen. c. Pack the wound lightly with a wet-to-dry dressing. d. Provide a well-balanced diet with high-quality protein.: d. Provide a well- bal-anced diet with high-quality protein.

  1. The nurse assesses a patient with a surgical incision. What is an expected patient outcome on the fourth postoperative day? Select one: a. The tympanic temperature is 39.5° C at 8 AM and noon. b. The incision is slightly reddened and swollen without drainage. c. The skin is spongy and warm around the incision. d. The patient's pain has been increasing gradually:. b. The incision is slightly reddened and swollen without drainage.
  2. The nurse is preparing to initiate a blood transfusion. Which step of the procedure should the nurse implement first? Select one: a. Begin the infusion at 2 mL/min. b. Establish a single-line infusion. c. Check vital signs in 30 minutes. d. Shake the blood gently to mix the preservative.: a. Begin the infusion at 2 mL/min.
  3. After inserting a peripheral intravenous (IV) line into the patient, the nurse provides patient teaching about the IV insertion site. What information should the nurse give to the patient? Select one: a. Expect minor pain at the insertion site. b. Report redness at the insertion site. c. Remain on bed rest with the IV infusion. d. Disconnect IV tubing to change a gown.: b. Report redness at the insertion site.
  4. The nurse assesses the patient's intravenous (IV) site. Which clinical indi- cator does the nurse recognize as being consistent for phlebitis? Select one: a. An elevated heart rate b. Decreased skin temperature c. Erythema along the vein line d. Edema around the insertion site: c. Erythema along the vein line
  5. The prescription for the patient's intravenous (IV) fluid reads, "Infuse 1000 mL over 10 hours." At which rate does the nurse infuse the IV fluids using IV

tubing with a drop factor of 15 gtts/mL? Select one: a. 20 gtts/min b. 25 gtts/min c. 30 gtts/min d. 32 gtts/min: b. 25 gtts/min

  1. The health care provider prescribes 500 mL of 0.25% normal saline (1/ NS) intravenously over 4 hours for the patient. At which rate does the nurse infuse the intravenous (IV) solution into the patient using IV tubing with a drop factor of 15 gtts/mL? Select one: a. 125 mL/hr b. 31 mL/min c. 31 gtts/min d. 125 gtts/min: c. 31 gtts/min
  2. The nurse prepares to administer blood to the patient. Which is the nurse's priority action? Select one: a. Determining patient history of autologous blood donations b. Assessing patient baseline vital signs before the transfusion c. Confirming the rate of the blood infusion with the health care provider d. Identifying patient blood type, cross-match, and blood product: d. Identifying patient blood type, cross-match, and blood product
  3. The prescription for the patient's intravenous (IV) infusion reads, " mL/hr." The nurse observes that the patient's IV line infused 125 mL in addition to the ordered volume after 2 hours. Which is the most important intervention for the nurse to implement? Select one: a. Compare weight to baseline data. b. Replace the infusion pump batteries. c. Assess the patient for respiratory distress. d. Reduce the infusion rate below 75 mL/hr.: c. Assess the patient for respiratory distress.
  4. The order calls for the patient to receive 500 mL of intravenous (IV) fluid over 4 hours, and the nurse uses IV tubing with a drop factor at 10 gtts/mL. Which rate should the nurse use on an electronic infusion pump for IV fluids to administer this prescription? Select one: a. 125 mL/hr

c. Complete the vital signs. d. Remove the intravenous (IV) tubing.: d. Remove the intravenous (IV) tubing.

  1. The nurse infuses a unit of blood, but after 4 hours the blood infusion is not complete. Which action should the nurse implement? Select one: a. Check the intravenous (IV) access for patency. b. Increase the infusion rate of the blood. c. Discontinue the blood infusion. d. Assess the patient for an ABO mismatch.: c. Discontinue the blood infusion.
  2. The nurse observes that the patient's left cephalic intravenous (IV) site is cool, swollen, and mildly tender, although the IV line is infusing at the prescribed rate. Which action should the nurse take first? Select one: a. Instruct the patient to elevate his or her arm on two pillows. b. Discontinue the IV infusion and start one in the right arm. c. Apply a warm, moist compress to the IV site. d. Reassess the IV site in 2 hours for any change.: b. Discontinue the IV infusion and start one in the right arm.
  3. The patient has an intermittent infusion device inserted in the hand. Which strategy should the nurse use related to prevention of dislodging the patient's intravenous (IV) access? Select one: a. Instruct the patient how to protect IV site. b. Apply a new sterile dressing every day. c. Change the IV tubing at least daily. d. Flush the IV catheter every morning.: a. Instruct the patient how to protect IV site.
  4. A patient on an anticoagulant is going home and needs his peripheral intravenous (IV) line removed. Which action is essential for the nurse to take? Select one: a. Pull the IV catheter out smoothly but quickly. b. Apply sterile gloves before going to the patient's bedside. c. Check the most recent clotting studies. d. Apply pressure over the insertion after removal of the IV line for 5 to 10 minutes.: d. Apply pressure over the insertion after removal of the IV line for 5 to 10 minutes.
  5. The nurse assesses the patient and determines that he may be at risk for altered peripheral tissue perfusion. Which activity should the nurse include in patient teaching to prevent decreased perfusion to his extremities while he is

on bed rest? Select one: a. Avoid any fluids by mouth until the patient begins passing gas. b. Flex and rotate the ankles several times every hour while awake. c. Rest quietly to allow the maximum action of the opioid analgesics. d. Stay positioned on either side with pillows between the legs.: b. Flex and rotate the ankles several times every hour while awake.

  1. The nurse instructs the patient about postoperative coughing and deep-breathing exercises. Which technique should the nurse use to engage the patient in prevention of pneumonia and atelectasis? Select one: a. Begin coughing and deep breathing when the patient is ready. b. Take a deep breath, hold it for 10 seconds, and exhale slowly. c. Support the incision when doing these exercises. d. Begin coughing and deep breathing when the patient is wide awake: c. Support the incision when doing these exercises.