NUR 215 Exam 1: Fundamentals V2 - Arizona College
Updated and Latest Questions and Correct Answers with
Rationale
1. Which action is the priority for a nurse when a patient’s fire alarm sounds in a hospital setting?
A. Rescue any patients in immediate danger
B. Confine the fire by closing doors
C. Extinguish the fire immediately
D. Activate the fire alarm system
Ans: A
Explanation: The RACE acronym guides nursing actions during a fire emergency. The first priority is
always to rescue and remove patients from immediate danger. After ensuring patient safety, the nurse
should then activate the alarm and contain the fire. This sequence prioritizes human life over property
preservation. Following these steps systematically ensures a coordinated and effective emergency
response.
2. What is the most effective technique for the nurse to prevent the spread of healthcare-associated
infections?
A. Proper hand hygiene
B. Wearing gloves at all times
C. Using prophylactic antibiotics
D. Routine patient isolation
Ans: A
,Explanation: Hand hygiene is recognized as the single most important practice for reducing the
transmission of pathogens. It should be performed before and after every patient contact to maintain
safety. While gloves provide a barrier, they do not replace the need for thorough hand washing. Effective
hand hygiene significantly lowers the risk of cross-contamination between patients and staff. Consistency
in this practice is vital for high-quality patient care and infection control.
3. A nurse is measuring a patient’s blood pressure and finds the cuff is too small. What is the likely result?
A. A falsely low reading
B. An accurate reading
C. A falsely high reading
D. No reading can be obtained
Ans: C
Explanation: Using a blood pressure cuff that is too narrow or small will result in a falsely elevated
measurement. The cuff must be the appropriate size to properly compress the underlying artery. If the
cuff is too large, the resulting blood pressure reading will be falsely low. Accuracy in vital sign
measurement is critical for determining a patient’s clinical status. Nurses must select the correct
equipment size based on the patient’s physical characteristics.
4. Which phase of the nursing process involves the nurse collecting subjective and objective data?
A. Diagnosis
B. Planning
C. Assessment
D. Implementation
Ans: C
, Explanation: Assessment is the foundational phase of the nursing process where data collection occurs.
It involves gathering subjective information from the patient and objective data through observation.
This systematic process allows the nurse to identify the patient’s health needs and concerns. Without a
complete assessment, subsequent steps like planning and intervention cannot be accurately performed. It
is an ongoing process that continues throughout the entire duration of patient care.
5. A nurse is preparing to provide oral care to an unconscious patient. What is the priority safety
intervention?
A. Using a small amount of water
B. Ensuring the patient is in semi-Fowler’s
C. Placing the patient in a side-lying position
D. Using a firm toothbrush for cleaning
Ans: C
Explanation: The side-lying position is essential for preventing aspiration in an unconscious patient
during oral care. This position allows fluids to drain out of the mouth by gravity rather than down the
trachea. Aspiration of oral secretions or water can lead to serious respiratory complications like
pneumonia. Maintaining a patent airway is always the primary concern for patients with a decreased
level of consciousness. Nurses must prioritize safety measures that protect the patient’s respiratory
function.
6. Which of the following is an example of an open-ended question during a patient interview?
A. ‘How have you been managing your pain at home?’
B. ‘Are you feeling better today?’
C. ‘Did you take your medication this morning?’
Updated and Latest Questions and Correct Answers with
Rationale
1. Which action is the priority for a nurse when a patient’s fire alarm sounds in a hospital setting?
A. Rescue any patients in immediate danger
B. Confine the fire by closing doors
C. Extinguish the fire immediately
D. Activate the fire alarm system
Ans: A
Explanation: The RACE acronym guides nursing actions during a fire emergency. The first priority is
always to rescue and remove patients from immediate danger. After ensuring patient safety, the nurse
should then activate the alarm and contain the fire. This sequence prioritizes human life over property
preservation. Following these steps systematically ensures a coordinated and effective emergency
response.
2. What is the most effective technique for the nurse to prevent the spread of healthcare-associated
infections?
A. Proper hand hygiene
B. Wearing gloves at all times
C. Using prophylactic antibiotics
D. Routine patient isolation
Ans: A
,Explanation: Hand hygiene is recognized as the single most important practice for reducing the
transmission of pathogens. It should be performed before and after every patient contact to maintain
safety. While gloves provide a barrier, they do not replace the need for thorough hand washing. Effective
hand hygiene significantly lowers the risk of cross-contamination between patients and staff. Consistency
in this practice is vital for high-quality patient care and infection control.
3. A nurse is measuring a patient’s blood pressure and finds the cuff is too small. What is the likely result?
A. A falsely low reading
B. An accurate reading
C. A falsely high reading
D. No reading can be obtained
Ans: C
Explanation: Using a blood pressure cuff that is too narrow or small will result in a falsely elevated
measurement. The cuff must be the appropriate size to properly compress the underlying artery. If the
cuff is too large, the resulting blood pressure reading will be falsely low. Accuracy in vital sign
measurement is critical for determining a patient’s clinical status. Nurses must select the correct
equipment size based on the patient’s physical characteristics.
4. Which phase of the nursing process involves the nurse collecting subjective and objective data?
A. Diagnosis
B. Planning
C. Assessment
D. Implementation
Ans: C
, Explanation: Assessment is the foundational phase of the nursing process where data collection occurs.
It involves gathering subjective information from the patient and objective data through observation.
This systematic process allows the nurse to identify the patient’s health needs and concerns. Without a
complete assessment, subsequent steps like planning and intervention cannot be accurately performed. It
is an ongoing process that continues throughout the entire duration of patient care.
5. A nurse is preparing to provide oral care to an unconscious patient. What is the priority safety
intervention?
A. Using a small amount of water
B. Ensuring the patient is in semi-Fowler’s
C. Placing the patient in a side-lying position
D. Using a firm toothbrush for cleaning
Ans: C
Explanation: The side-lying position is essential for preventing aspiration in an unconscious patient
during oral care. This position allows fluids to drain out of the mouth by gravity rather than down the
trachea. Aspiration of oral secretions or water can lead to serious respiratory complications like
pneumonia. Maintaining a patent airway is always the primary concern for patients with a decreased
level of consciousness. Nurses must prioritize safety measures that protect the patient’s respiratory
function.
6. Which of the following is an example of an open-ended question during a patient interview?
A. ‘How have you been managing your pain at home?’
B. ‘Are you feeling better today?’
C. ‘Did you take your medication this morning?’
