NURS 113 Exam Questions With 100% Verified Answers
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Course
NUR 113
Institution
NUR 113
NURS 113 Exam Questions With 100%
Verified Answers
Four for the door - answerThe patient's bed should be locked in place, at the lowest level, with
the call light in reach, and both side rails UP
What is the correct order for abdominal assessment - answerInspection, auscultation,
percussion, p...
NURS 113 Exam Questions With 100%
Verified Answers
Four for the door - answer✔The patient's bed should be locked in place, at the lowest level, with
the call light in reach, and both side rails UP
What is the correct order for abdominal assessment - answer✔Inspection, auscultation,
percussion, palpation.
Auscultation follows inspection because percussion and palpation can alter the frequency and
intensity of bowel sounds.
How often should normal bowel sounds be heard in each quadrant of the abdomen - answer✔5-
35 times per minute
Which of the following is an important part of performing an abdominal assessment? -
answer✔Explaining each step of the assessment to the patient
What should you do if a patient is ticklish when you are palpating the abdomen? - answer✔Place
your hand over the patient's hand during palpation.
Moderate and deep palpation of the abdomen:
A. May cause tenderness
B. Should not detect masses
C. May locate the margins of the liver
D. All of the above - answer✔D. All of the above
Which action would a nurse take to ensure the safety of an older adult patient who has received
an enema? - answer✔Provide assistance to the bathroom for expulsion of fluid and stool
A nurse is preparing to administer an enema. How can the nurse best facilitate the insertion of
the rectal tube? - answer✔Lubricate the first 6.5 to 7.5 cm (2.5 to 3 inches) of the tip of the tube
A nurse is delegating to NAP the administration of an emma for an older adult patient. The
enema order reads, "Enemas until clear." Which statement made by NAP requires the nurse to
follow up?
A. "I'll need help to turn her onto her side."
B. "It may take three or four enemas to achieve a clear return."
C. "I'll test the water temperature in the inside of my own wrist."
D. "The enema will wear her out, so I'll wait until after she ambulates." - answer✔B
The nurse has delegated administration of a standard enema for a 72-year-old patient with
constipation. Which statement made by nursing assistive personnel (NAP) requires the nurse to
follow-up? - answer✔"I'll instill the solution and then check in on my other patients until I get
the call signal."
Which action would the nurse take to reduce the risk of infection among patients and staff when
administering an enema to an older adult patient with dementia? - answer✔Perform hand
hygiene before donning gloves.
1. The nurse has delegated to nursing assistive personnel (NAP) the skill of assisting with a
bedpan for a patient who has had discomfort when walking to the bathroom. Which statement
made by the NAP requires the nurse's follow-up?
A. "Do you still need a stool sample for the lab?"
B. "If I can get someone to help, I'll walk her to the bathroom."
C. "The patient reports that moving is uncomfortable for her. Has she had pain medication
recently?"
D. "The patient told me that she's had problems with hemorrhoids in the past." - answer✔B. The
NAP is not qualified to determine whether it is appropriate to ambulate a patient
2. A patient with a nasogastric tube, an intravenous infusion line, and an indwelling urinary
catheter needs to be placed on the bedpan. Which action would the nurse take first to ensure the
patient's safety? - answer✔Obtain help to place the patient in the bed pan
A dependent, confused patient is being given a bedpan. How can the nurse best ensure the
patient's safety?
A. Respond promptly to the call light.
B. Raise the side rails on the bed before leaving the room.
C. Slide one hand under the patient's sacrum to help the patient lift off the bedpan.
D. Check in on the patient every 5 minutes until the bedpan can be removed. - answer✔B
The nurse is assisting with a bedpan for a patient who had knee surgery 24 hours ago. What is
the best way for the nurse to maximize comfort while the patient uses the bedpan? -
answer✔Elevate the head of the bed to between 30 and 60 degrees
After assisting with a bedpan, the nurse notes the patient's stool is streaked with bright-red blood.
What would the nurse do first? - answer✔Ask if the patient has a history of hemorrhoids
What is the nurse's initial action when preparing to change a patient's colostomy pouching
system? - answer✔Applying clean gloves
When pouching a patient's colostomy, which action reduces the patient's risk for injury?
A. Measuring output when emptying the contents of the pouch
B. Maintaining the patient's bowel elimination function
C. Promoting the patient's autonomy with bowel elimination care
D. Protecting the skin from irritation caused by fecal drainage - answer✔D
When changing the pouching system, which routine step best minimizes irritation of the skin
surrounding the stoma?
A. Using adhesive remover
B. Emptying the ostomy bag only when full
C. Avoiding unnecessary changes of the pouching system
D. Wearing clean gloves - answer✔C. Avoiding unnecessary changes of the pouching system
Rationale: Each pouching system change increases the risk of irritating the surrounding skin
tissue.
Which initial nursing action would best help the patient learn self-care of a colostomy pouching
system?
A. Giving the patient handouts on self care of a colostomy
B. Allowing the patient to examine an ostomy device
C. Identifying a family member who can participate in the ostomy appliance process
D. Giving the patient a handheld mirror to watch the nurse provide care - answer✔D. Giving the
patient a handheld mirror to watch the nurse provide care
Which instruction might the nurse give to nursing assistive personnel (NAP) regarding the care
of a patient with a newly established colostomy?
A. "Be sure to pat-dry the skin surrounding the stoma before applying the new pouch."
B. "Alert me immediately if you see any blood in the fecal matter in the pouch."
C. "Using the stoma guide, cut the pouch opening about one-eighth of an inch bigger than the
stoma."
D. "Remember to change your gloves after cleaning the stoma and the surrounding skin." -
answer✔B. No part of pouching a colostomy can be done by a NAP
What is included in the preparation for an assessment of the female genitalia?
A. Having the patient empty the bladder
B. Explaining the exam thoroughly if it is the patient's first exam
C. Laying the head of the table flat
D. Both A and B - answer✔D. Both A and B
When should gloves be changed or discarded?
A. After touching the genital skin
B. After completing the internal vaginal exam
C. After completing the rectal exam
D. All of the above - answer✔D. All of the above
Which description is consistent with normal vaginal secretions?
A. Clear, thick, and with a fishy odor
B. Clear or cloudy, and odorless or with a slight odor
C. Yellow, thin, and with a strong odor
D. Green, thick, and with a foul odor - answer✔B. Clear or cloudy, and odorless or with a slight
odor
Rationale: Vaginal secretions that are clear or cloudy, and odorless or with a slight odor are a
normal finding.
What is a Pap smear?
A. A screening test for cervical cancer
B. A screening test for colon cancer
C. A screening test for sexually transmitted diseases
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