TIA Fundamentals of Nursing 2 — Questions and Answers
Question 1: A nurse is preparing to insert a urinary catheter. Which step should be performed first?
- Open the sterile catheter kit
- Cleanse the urinary meatus
- Apply sterile gloves
- Explain the procedure to the patient (Correct answer)
Correct answer: Explain the procedure to the patient
Patient education and consent must occur before initiating any invasive procedure.
Question 2: Which of the following findings is a classic sign of dehydration in an adult patient?
- Bradycardia
- Bounding peripheral pulses
- Decreased skin turgor (Correct answer)
- Hypertension
Correct answer: Decreased skin turgor
Decreased skin turgor (tenting) is a classic sign of dehydration caused by loss of interstitial fluid.
Question 3: A nurse is caring for a postoperative client using a PCA pump. Which finding requires immediate intervention?
- Client rates pain as 3/10
- Respiratory rate of 8 breaths/min (Correct answer)
- Client is able to self-administer doses
- Oxygen saturation of 96%
Correct answer: Respiratory rate of 8 breaths/min
A respiratory rate of 8 breaths/min indicates opioid-induced respiratory depression, which is a life-threatening emergency.
Question 4: Which nursing action best demonstrates the principle of beneficence?
- Allowing a client to refuse treatment
- Administering analgesics to relieve a client's pain (Correct answer)
- Maintaining a client's confidentiality
- Distributing resources fairly among patients
Correct answer: Administering analgesics to relieve a client's pain
Beneficence means acting in the best interest of the patient, such as providing pain relief.
Question 5: A nurse is changing a wound dressing. Which action maintains sterile technique?
- Reaching across the sterile field to retrieve supplies
- Placing sterile items 1 inch from the edge of the sterile drape
- Wearing clean (non-sterile) gloves throughout
- Keeping the sterile field in view at all times (Correct answer)
Correct answer: Keeping the sterile field in view at all times
The sterile field must remain in constant view to ensure it is not contaminated.
Question 6: What is the correct needle angle for an intramuscular (IM) injection?
- 10–15 degrees
- 45 degrees
- 90 degrees (Correct answer)
- 60 degrees
Correct answer: 90 degrees
IM injections are administered at a 90-degree angle to ensure the medication reaches the muscle tissue.
TIA Fundamentals of Nursing 2
A nurse is preparing to insert a urinary catheter.
Which step should be performed first?