NRSG 100 Final Exam V3 | NRSG 100
Fundamentals of Nursing | Actual Q&A
with Rationale (NRSG100 Final Exam) | Ivy
Tech
1. A nurse is preparing to measure a client’s blood pressure. Which action should the nurse
take to ensure an accurate measurement?
A. Use a cuff with a bladder that covers 50% of the arm circumference.
B. Deflate the cuff at a rate of 5 to 10 mmHg per second.
C. Support the client’s arm above the level of the heart.
D. Position the client’s arm at the level of the heart.
Correct Answer: D
Proper positioning of the arm at heart level is essential to prevent false readings due to
hydrostatic pressure. If the arm is above heart level, the reading may be falsely low,
whereas an arm below heart level can result in a falsely high reading. This fundamental
skill is a core competency in the Ivy Tech nursing curriculum for accurate clinical
assessment.
2. Which stage of the nursing process is the nurse performing when they compare a client’s
current health status with the established goals?
A. Assessment
,B. Evaluation
C. Implementation
D. Planning
Correct Answer: B
Evaluation is the final step of the nursing process where the nurse determines if the
client’s outcomes were met. It involves a systematic comparison of the patient’s progress
against the goals set during the planning phase. If goals are not met, the nurse must
reassess and modify the care plan accordingly.
3. A nurse is caring for a client who is on contact precautions. Which of the following actions
is appropriate?
A. Wearing a mask when working within 3 feet of the client.
B. Gowning and gloving before entering the client’s room.
C. Placing the client in a room with negative pressure airflow.
D. Using a dedicated stethoscope that stays in the room.
Correct Answer: B
Contact precautions require healthcare workers to wear a gown and gloves for all
interactions that may involve contact with the patient or their environment. This prevents
the transmission of infectious agents such as MRSA or VRE. Consistent use of personal
protective equipment (PPE) is a critical safety standard taught in NRSG 100.
, 4. Which of the following is the most effective way to prevent the spread of healthcare-
associated infections?
A. Wearing clean gloves for all patient contact.
B. Using a mask when providing care to surgical patients.
C. Administering prophylactic antibiotics to all patients.
D. Performing consistent and thorough hand hygiene.
Correct Answer: D
Hand hygiene is universally recognized as the single most important intervention in
preventing the transmission of pathogens. It should be performed before and after every
patient contact, regardless of whether gloves were worn. Failure to perform hand hygiene
is the primary cause of cross-contamination in clinical settings.
5. A client is experiencing difficulty swallowing (dysphagia). Which nursing intervention is a
priority to prevent aspiration?
A. Encouraging the client to use a straw for liquids.
B. Feeding the client quickly to reduce fatigue.
C. Placing the client in a high-Fowler’s position during meals.
D. Providing thin liquids to make swallowing easier.
Correct Answer: C
Fundamentals of Nursing | Actual Q&A
with Rationale (NRSG100 Final Exam) | Ivy
Tech
1. A nurse is preparing to measure a client’s blood pressure. Which action should the nurse
take to ensure an accurate measurement?
A. Use a cuff with a bladder that covers 50% of the arm circumference.
B. Deflate the cuff at a rate of 5 to 10 mmHg per second.
C. Support the client’s arm above the level of the heart.
D. Position the client’s arm at the level of the heart.
Correct Answer: D
Proper positioning of the arm at heart level is essential to prevent false readings due to
hydrostatic pressure. If the arm is above heart level, the reading may be falsely low,
whereas an arm below heart level can result in a falsely high reading. This fundamental
skill is a core competency in the Ivy Tech nursing curriculum for accurate clinical
assessment.
2. Which stage of the nursing process is the nurse performing when they compare a client’s
current health status with the established goals?
A. Assessment
,B. Evaluation
C. Implementation
D. Planning
Correct Answer: B
Evaluation is the final step of the nursing process where the nurse determines if the
client’s outcomes were met. It involves a systematic comparison of the patient’s progress
against the goals set during the planning phase. If goals are not met, the nurse must
reassess and modify the care plan accordingly.
3. A nurse is caring for a client who is on contact precautions. Which of the following actions
is appropriate?
A. Wearing a mask when working within 3 feet of the client.
B. Gowning and gloving before entering the client’s room.
C. Placing the client in a room with negative pressure airflow.
D. Using a dedicated stethoscope that stays in the room.
Correct Answer: B
Contact precautions require healthcare workers to wear a gown and gloves for all
interactions that may involve contact with the patient or their environment. This prevents
the transmission of infectious agents such as MRSA or VRE. Consistent use of personal
protective equipment (PPE) is a critical safety standard taught in NRSG 100.
, 4. Which of the following is the most effective way to prevent the spread of healthcare-
associated infections?
A. Wearing clean gloves for all patient contact.
B. Using a mask when providing care to surgical patients.
C. Administering prophylactic antibiotics to all patients.
D. Performing consistent and thorough hand hygiene.
Correct Answer: D
Hand hygiene is universally recognized as the single most important intervention in
preventing the transmission of pathogens. It should be performed before and after every
patient contact, regardless of whether gloves were worn. Failure to perform hand hygiene
is the primary cause of cross-contamination in clinical settings.
5. A client is experiencing difficulty swallowing (dysphagia). Which nursing intervention is a
priority to prevent aspiration?
A. Encouraging the client to use a straw for liquids.
B. Feeding the client quickly to reduce fatigue.
C. Placing the client in a high-Fowler’s position during meals.
D. Providing thin liquids to make swallowing easier.
Correct Answer: C
