PNR 106/PNR106 Final Exam V1 | Foundations of
Nursing Q&A with Rationale | Fortis College
1. Which phase of the nursing process involves the nurse prioritizing patient problems and
identifying measurable goals?
A. Assessment
B. Implementation
C. Evaluation
D. Planning
Correct Answer: D
Explanation: The planning phase is where the nurse sets priorities and establishes goals in
collaboration with the patient. These goals must be SMART: specific, measurable,
attainable, realistic, and timed. This phase serves as a bridge between identifying a
problem and taking action.
2. A nurse is preparing to perform hand hygiene before patient contact. What is the minimum
recommended duration for rubbing hands with soap and water?
A. 5 seconds
B. 10 seconds
C. 1 minute
D. 20 seconds
,Correct Answer: D
Explanation: According to the CDC and foundational nursing standards, hands should be
rubbed vigorously for at least 15 to 20 seconds. This friction is necessary to remove
transient microorganisms from the skin surface. Proper hand hygiene is the single most
effective way to prevent the spread of infection.
3. A patient reports a sharp pain in their abdomen rated at an 8 on a 1-10 scale. Which type of
data does this information represent?
A. Subjective data
B. Secondary data
C. Objective data
D. Indirect data
Correct Answer: A
Explanation: Subjective data consists of the patient’s verbal descriptions of their health
problems, such as pain levels or feelings. Unlike objective data, which can be measured or
observed, subjective data is what the patient says. It is essential for the nurse to document
these statements exactly as reported by the patient.
4. Which ethical principle is the nurse upholding when they respect a patient’s right to refuse
a recommended medical treatment?
A. Beneficence
B. Autonomy
, C. Justice
D. Fidelity
Correct Answer: B
Explanation: Autonomy refers to the right of patients to make their own decisions about
their medical care without being influenced by healthcare providers. This principle
requires that the nurse provides the patient with all necessary information to make an
informed choice. Respecting autonomy is a cornerstone of professional nursing ethics.
5. A nurse is caring for a patient on bed rest. Which intervention is most effective in
preventing deep vein thrombosis (DVT)?
A. Massaging the patient’s calves
B. Applying sequential compression devices (SCDs)
C. Encouraging passive range-of-motion exercises
D. Restricting fluid intake
Correct Answer: B
Explanation: Sequential compression devices promote venous return by applying
intermittent pressure to the legs. This prevents blood stasis, which is a major risk factor for
clot formation. Nurses must ensure the sleeves are applied correctly and that the machine
is functioning whenever the patient is in bed.
Nursing Q&A with Rationale | Fortis College
1. Which phase of the nursing process involves the nurse prioritizing patient problems and
identifying measurable goals?
A. Assessment
B. Implementation
C. Evaluation
D. Planning
Correct Answer: D
Explanation: The planning phase is where the nurse sets priorities and establishes goals in
collaboration with the patient. These goals must be SMART: specific, measurable,
attainable, realistic, and timed. This phase serves as a bridge between identifying a
problem and taking action.
2. A nurse is preparing to perform hand hygiene before patient contact. What is the minimum
recommended duration for rubbing hands with soap and water?
A. 5 seconds
B. 10 seconds
C. 1 minute
D. 20 seconds
,Correct Answer: D
Explanation: According to the CDC and foundational nursing standards, hands should be
rubbed vigorously for at least 15 to 20 seconds. This friction is necessary to remove
transient microorganisms from the skin surface. Proper hand hygiene is the single most
effective way to prevent the spread of infection.
3. A patient reports a sharp pain in their abdomen rated at an 8 on a 1-10 scale. Which type of
data does this information represent?
A. Subjective data
B. Secondary data
C. Objective data
D. Indirect data
Correct Answer: A
Explanation: Subjective data consists of the patient’s verbal descriptions of their health
problems, such as pain levels or feelings. Unlike objective data, which can be measured or
observed, subjective data is what the patient says. It is essential for the nurse to document
these statements exactly as reported by the patient.
4. Which ethical principle is the nurse upholding when they respect a patient’s right to refuse
a recommended medical treatment?
A. Beneficence
B. Autonomy
, C. Justice
D. Fidelity
Correct Answer: B
Explanation: Autonomy refers to the right of patients to make their own decisions about
their medical care without being influenced by healthcare providers. This principle
requires that the nurse provides the patient with all necessary information to make an
informed choice. Respecting autonomy is a cornerstone of professional nursing ethics.
5. A nurse is caring for a patient on bed rest. Which intervention is most effective in
preventing deep vein thrombosis (DVT)?
A. Massaging the patient’s calves
B. Applying sequential compression devices (SCDs)
C. Encouraging passive range-of-motion exercises
D. Restricting fluid intake
Correct Answer: B
Explanation: Sequential compression devices promote venous return by applying
intermittent pressure to the legs. This prevents blood stasis, which is a major risk factor for
clot formation. Nurses must ensure the sleeves are applied correctly and that the machine
is functioning whenever the patient is in bed.
