foundations of nursing practice questions

Correct Answer: C

Rationale: Correct Answer: C - Used crutches with no difficulties Rationale: 1. "Used crutches with no difficulties" reflects the patient's successful application of the taught skill. 2. This information indicates the patient's ability to independently perform the task. 3. It demonstrates the effectiveness of the teaching provided by the nurse. 4. "Used crutches with no difficulties" is a specific and objective observation of the patient's performance. Summary: A. "Patient went up and down stairs" is too general and does not indicate the patient's proficiency. B. "Demonstrated use of crutches" does not confirm the patient's actual performance. D. "Deficient knowledge related to never using crutches" is incorrect as it does not reflect the patient's successful use of crutches.

Correct Answer: C

Rationale: Correct Answer: C - Used crutches with no difficulties Rationale: 1. "Used crutches with no difficulties" reflects the patient's successful application of the taught skill. 2. This information indicates the patient's ability to independently perform the task. 3. It demonstrates the effectiveness of the teaching provided by the nurse. 4. "Used crutches with no difficulties" is a specific and objective observation of the patient's performance. Summary: A. "Patient went up and down stairs" is too general and does not indicate the patient's proficiency. B. "Demonstrated use of crutches" does not confirm the patient's actual performance. D. "Deficient knowledge related to never using crutches" is incorrect as it does not reflect the patient's successful use of crutches.

Correct Answer: B

Rationale: The correct answer is B: Report to the emergency department or employee health department. 1. Immediate action is crucial after exposure to HIV-positive blood. 2. Reporting to the emergency department or employee health department ensures prompt evaluation and appropriate management. 3. The supervisor should also be informed to initiate the necessary protocols. 4. The other choices are incorrect: - A: Chlorhexidine may not be sufficient for post-exposure prophylaxis. - C: Hydrocolloid dressing is not appropriate for managing needlestick injuries. - D: Following up with the primary care provider may cause delays in receiving timely post-exposure prophylaxis.

Correct Answer: C

Rationale: The correct answer is C because documenting medication administration is critical for patient safety and continuity of care. By documenting the pain medication received, the nurse ensures accurate medication tracking and prevents errors. Choice A is incorrect as it lacks specific, objective information. Choice B is irrelevant to patient care. Choice D is inappropriate and violates patient confidentiality.

Correct Answer: B

Rationale: The correct answer is B: Jejunostomy tube. This tube is chosen because the patient has a history of aspiration pneumonia, which puts them at risk for aspiration if feeds are administered into the stomach. By administering feeds through a jejunostomy tube, the risk of aspiration pneumonia is minimized as the feed bypasses the stomach. Nasogastric tube (A) and Nasointestinal tube (C) would still deliver feeds to the stomach, increasing the risk of aspiration. PEG tube (D) is also not ideal as it delivers feeds directly to the stomach, which is not recommended for patients at risk for aspiration.