Foundations of Nursing Practice Flashcards
7 cards from real NACE practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Foundations of Nursing Practice flashcards as text
A nurse is caring for a client who refuses a prescribed blood transfusion for religious reasons. Which action best reflects the ethical principle of autonomy?
Answer: Document the refusal and notify the physician without proceeding
Autonomy requires respecting a competent client's right to refuse treatment; the nurse documents the refusal and informs the provider.
Which position is most appropriate for a client experiencing respiratory distress to maximize lung expansion?
Answer: High Fowler's (90 degrees)
High Fowler's position uses gravity to lower abdominal organs and allows maximum diaphragmatic excursion and lung expansion.
A nurse notes a discrepancy between the medication administration record (MAR) and the number of controlled substance tablets remaining. What is the priority action?
Answer: Report the discrepancy to the charge nurse immediately
A controlled substance discrepancy must be reported immediately to the charge nurse and investigated per institutional policy.
Which laboratory value indicates that a client receiving heparin therapy is within the therapeutic range?
Answer: aPTT 60 seconds (1.5-2.5x control)
Therapeutic heparin effect is reflected by an aPTT of 1.5–2.5 times the control (approximately 60–80 seconds).
A client is admitted with a stage III pressure injury to the sacrum. Which intervention has the highest priority?
Answer: Reposition the client every 2 hours
Turning and repositioning every 2 hours is the primary prevention and treatment intervention to relieve pressure and promote healing.
A nurse uses the SBAR communication technique when calling a physician. Which component is 'A' in SBAR?
Answer: Assessment of the client's current condition
In SBAR, 'A' stands for Assessment, which is the nurse's clinical interpretation of the situation.
Which nursing action is the single most effective method for preventing the transmission of healthcare-associated infections?
Answer: Performing proper hand hygiene before and after client care
Hand hygiene is consistently identified as the most effective measure to prevent the spread of healthcare-associated infections.