NACE Foundations of Nursing 3

Question 1

A nurse is preparing to perform a sterile dressing change. Which action breaks sterile technique?

Accepted Answer

Placing sterile items at the edge of the sterile drape (1 inch border)

Answer

The 1-inch border around a sterile drape is considered contaminated; sterile items must be placed within the interior of the field.

Question 2

Which nursing action best demonstrates the principle of beneficence?

Accepted Answer

Administering ordered pain medication before a painful procedure

Answer

Beneficence means acting in the patient's best interest; proactively managing pain before a procedure promotes well-being.

Question 3

A patient's chart shows a temperature of 38.9°C. What is the equivalent Fahrenheit temperature?

Accepted Answer

102.0°F

Answer

Using the formula °F = (°C × 9/5) + 32: (38.9 × 1.8) + 32 = 70.02 + 32 = 102.02°F, which rounds to 102.0°F.

Question 4

When performing a head-to-toe physical assessment, in what order should the nurse assess the abdomen?

Accepted Answer

Inspection, auscultation, percussion, palpation

Answer

The abdomen is assessed by inspection first, then auscultation before percussion and palpation to avoid altering bowel sounds.

Question 5

A nurse notes that a patient's urine output has been 80 mL over the past 4 hours. How should the nurse interpret this finding?

Accepted Answer

Oliguria; requires further assessment and notification of provider

Answer

Normal urine output is at least 30 mL/hour; 80 mL over 4 hours equals only 20 mL/hour, which meets the definition of oliguria and requires provider notification.

Nursing Acceleration Challenge Exam (NACE) I PN-RN Practice Test

Nursing Acceleration Challenge Exam (NACE) I PN-RN Practice Test

NACE Foundations of Nursing 3