NUR 104/NUR104 Exam 1 V1 | Foundations
of Nursing Q&A with Rationale | Fortis
College
1. A nurse is performing a health assessment on a new patient. Which of the following is
considered objective data?
A. The patient’s report of a headache.
B. The patient’s description of pain level as 5/10.
C. The patient’s statement about feeling anxious.
D. The patient’s blood pressure reading of 140/90 mmHg.
Correct Answer: D
Expert Explanation: Objective data are observable and measurable signs that can be
verified by the nurse. A blood pressure reading is a physical measurement that does not
depend on the patient’s perspective. In contrast, subjective data like pain levels or feelings
of anxiety are reported by the patient and cannot be independently measured by the
clinician.
2. Which stage of the nursing process involves setting patient-centered goals and identifying
nursing interventions?
A. Assessment
B. Diagnosis
,C. Planning
D. Implementation
Correct Answer: C
Expert Explanation: The planning phase of the nursing process is where the nurse
prioritizes diagnoses and establishes expected outcomes. This phase also includes selecting
specific nursing interventions to achieve those goals. It serves as the blueprint for the care
provided during the implementation phase.
3. A nurse is caring for a patient who refuses a scheduled medication. Which ethical principle
is the nurse respecting by honoring this refusal?
A. Beneficence
B. Autonomy
C. Justice
D. Nonmaleficence
Correct Answer: B
Expert Explanation: Autonomy refers to the right of patients to make their own decisions
regarding their healthcare. When a nurse respects a patient’s refusal of treatment, they are
upholding the patient’s right to self-determination. The nurse’s role is to ensure the patient
is informed of the risks but ultimately to support the patient’s choice.
, 4. According to Maslow’s Hierarchy of Needs, which of the following patient needs should the
nurse address first?
A. Self-actualization
B. Safety and Security
C. Physiological needs
D. Love and Belonging
Correct Answer: C
Expert Explanation: Maslow’s Hierarchy of Needs prioritizes physiological needs, such as
oxygen, water, and food, as the foundation of health. These needs must be met before an
individual can focus on higher-level needs like safety or self-esteem. Nurses use this
framework to prioritize care for patients with multiple competing health issues.
5. A nurse is preparing to enter the room of a patient on Contact Precautions. Which of the
following PPE items must be donned?
A. N95 respirator
B. Gown and gloves
C. Surgical mask and goggles
D. Gloves only
Correct Answer: B
of Nursing Q&A with Rationale | Fortis
College
1. A nurse is performing a health assessment on a new patient. Which of the following is
considered objective data?
A. The patient’s report of a headache.
B. The patient’s description of pain level as 5/10.
C. The patient’s statement about feeling anxious.
D. The patient’s blood pressure reading of 140/90 mmHg.
Correct Answer: D
Expert Explanation: Objective data are observable and measurable signs that can be
verified by the nurse. A blood pressure reading is a physical measurement that does not
depend on the patient’s perspective. In contrast, subjective data like pain levels or feelings
of anxiety are reported by the patient and cannot be independently measured by the
clinician.
2. Which stage of the nursing process involves setting patient-centered goals and identifying
nursing interventions?
A. Assessment
B. Diagnosis
,C. Planning
D. Implementation
Correct Answer: C
Expert Explanation: The planning phase of the nursing process is where the nurse
prioritizes diagnoses and establishes expected outcomes. This phase also includes selecting
specific nursing interventions to achieve those goals. It serves as the blueprint for the care
provided during the implementation phase.
3. A nurse is caring for a patient who refuses a scheduled medication. Which ethical principle
is the nurse respecting by honoring this refusal?
A. Beneficence
B. Autonomy
C. Justice
D. Nonmaleficence
Correct Answer: B
Expert Explanation: Autonomy refers to the right of patients to make their own decisions
regarding their healthcare. When a nurse respects a patient’s refusal of treatment, they are
upholding the patient’s right to self-determination. The nurse’s role is to ensure the patient
is informed of the risks but ultimately to support the patient’s choice.
, 4. According to Maslow’s Hierarchy of Needs, which of the following patient needs should the
nurse address first?
A. Self-actualization
B. Safety and Security
C. Physiological needs
D. Love and Belonging
Correct Answer: C
Expert Explanation: Maslow’s Hierarchy of Needs prioritizes physiological needs, such as
oxygen, water, and food, as the foundation of health. These needs must be met before an
individual can focus on higher-level needs like safety or self-esteem. Nurses use this
framework to prioritize care for patients with multiple competing health issues.
5. A nurse is preparing to enter the room of a patient on Contact Precautions. Which of the
following PPE items must be donned?
A. N95 respirator
B. Gown and gloves
C. Surgical mask and goggles
D. Gloves only
Correct Answer: B
