NUR155/NUR 155 Exam 1 V1 | Critical
Thinking for the Practical Nurse Q&A with
Rationale | Hondros College of Nursing
1. A nurse is collecting data from a client who reports severe abdominal pain. Which of the
following is an example of subjective data?
A. The client’s heart rate is 105 beats per minute.
B. The nurse observes the client guarding their abdomen.
C. The client states, ‘It feels like a stabbing sensation.’
D. The client’s abdomen is firm upon palpation.
Correct Answer: C
Rationale: Subjective data includes information that only the client can perceive and
describe, such as pain or feelings. In this case, the verbal description of the sensation is
subjective because it cannot be measured by the nurse. Objective data would include the
heart rate, physical guarding, and abdominal firmness which are observable or measurable.
2. The nurse is using the nursing process to care for a group of clients. Which of the following
actions is part of the implementation phase?
A. Administering a scheduled antibiotic to a client.
B. Determining if the client met their weight loss goal.
C. Setting short-term goals for a client with pneumonia.
,D. Identifying a client’s risk for falls based on data.
Correct Answer: A
Rationale: The implementation phase involves carrying out the nursing interventions and
treatments planned for the client. Administering medication is a direct nursing action that
falls under this stage. Other phases mentioned include planning for goal setting, evaluation
for checking outcomes, and assessment for identifying risks.
3. When prioritizing client care, which client should the nurse see first according to Maslow’s
Hierarchy of Needs?
A. A client who is reporting difficulty breathing.
B. A client requesting information about their discharge.
C. A client who is crying because they are lonely.
D. A client who needs assistance with their morning bath.
Correct Answer: A
Rationale: According to Maslow’s Hierarchy, physiological needs such as oxygenation and
breathing are the highest priority for survival. Difficulty breathing represents a threat to
the client’s basic physiological stability and must be addressed immediately. Needs such as
love and belonging or self-actualization are addressed only after physiological and safety
needs are met.
, 4. A nurse is performing a physical assessment on a client. Which technique involves the
nurse using their sense of hearing to listen to body sounds?
A. Auscultation
B. Inspection
C. Percussion
D. Palpation
Correct Answer: A
Rationale: Auscultation is the process of listening to sounds produced within the body,
typically using a stethoscope. This technique is essential for assessing heart, lung, and
bowel sounds. In contrast, palpation uses touch, inspection uses sight, and percussion
involves tapping the body to produce vibration sounds.
5. The nurse demonstrates critical thinking when performing which of the following actions?
A. Following a procedure manual exactly without variation.
B. Recording vital signs as they are measured.
C. Checking a client’s ID band before giving a pill.
D. Questioning a medication order that seems abnormally high.
Correct Answer: D
Rationale: Critical thinking involves analysis and the willingness to question information
rather than accepting it blindly. By questioning a suspicious medication order, the nurse
Thinking for the Practical Nurse Q&A with
Rationale | Hondros College of Nursing
1. A nurse is collecting data from a client who reports severe abdominal pain. Which of the
following is an example of subjective data?
A. The client’s heart rate is 105 beats per minute.
B. The nurse observes the client guarding their abdomen.
C. The client states, ‘It feels like a stabbing sensation.’
D. The client’s abdomen is firm upon palpation.
Correct Answer: C
Rationale: Subjective data includes information that only the client can perceive and
describe, such as pain or feelings. In this case, the verbal description of the sensation is
subjective because it cannot be measured by the nurse. Objective data would include the
heart rate, physical guarding, and abdominal firmness which are observable or measurable.
2. The nurse is using the nursing process to care for a group of clients. Which of the following
actions is part of the implementation phase?
A. Administering a scheduled antibiotic to a client.
B. Determining if the client met their weight loss goal.
C. Setting short-term goals for a client with pneumonia.
,D. Identifying a client’s risk for falls based on data.
Correct Answer: A
Rationale: The implementation phase involves carrying out the nursing interventions and
treatments planned for the client. Administering medication is a direct nursing action that
falls under this stage. Other phases mentioned include planning for goal setting, evaluation
for checking outcomes, and assessment for identifying risks.
3. When prioritizing client care, which client should the nurse see first according to Maslow’s
Hierarchy of Needs?
A. A client who is reporting difficulty breathing.
B. A client requesting information about their discharge.
C. A client who is crying because they are lonely.
D. A client who needs assistance with their morning bath.
Correct Answer: A
Rationale: According to Maslow’s Hierarchy, physiological needs such as oxygenation and
breathing are the highest priority for survival. Difficulty breathing represents a threat to
the client’s basic physiological stability and must be addressed immediately. Needs such as
love and belonging or self-actualization are addressed only after physiological and safety
needs are met.
, 4. A nurse is performing a physical assessment on a client. Which technique involves the
nurse using their sense of hearing to listen to body sounds?
A. Auscultation
B. Inspection
C. Percussion
D. Palpation
Correct Answer: A
Rationale: Auscultation is the process of listening to sounds produced within the body,
typically using a stethoscope. This technique is essential for assessing heart, lung, and
bowel sounds. In contrast, palpation uses touch, inspection uses sight, and percussion
involves tapping the body to produce vibration sounds.
5. The nurse demonstrates critical thinking when performing which of the following actions?
A. Following a procedure manual exactly without variation.
B. Recording vital signs as they are measured.
C. Checking a client’s ID band before giving a pill.
D. Questioning a medication order that seems abnormally high.
Correct Answer: D
Rationale: Critical thinking involves analysis and the willingness to question information
rather than accepting it blindly. By questioning a suspicious medication order, the nurse
