NU 136 Exam 2 – Fundamentals of Nursing: Complete
300 Practice Questions with Verified Answers
## SECTION 1: NURSING PROCESS, ASSESSMENT & DOCUMENTATION
(Questions 1-50)
**Q1. A nurse is caring for a client who has a new diagnosis of diabetes mellitus. What is
the first action the nurse should take?**
A) Administer insulin as prescribed
B) Check the client's blood glucose level
C) Teach the client how to use a glucometer
D) Evaluate the effectiveness of dietary changes
**Correct Answer: B**
**Rationale:** Assessment is the first phase of the nursing process and involves
collecting objective and subjective data. Checking blood glucose is a data collection
activity. Administration and teaching are implementation activities, and evaluation is the
final step of the nursing process .
---
**Q2. A nurse is planning care for a client who is post-operative following a hip
replacement. Which of the following outcomes is correctly written?**
A) "The client will walk 50 feet by discharge"
,B) "The client will ambulate independently"
C) "The client will be pain-free"
D) "The nurse will assist the client with walking"
**Correct Answer: A**
**Rationale:** A correctly written outcome is specific, measurable, achievable, realistic,
and time-bound (SMART). "The client will walk 50 feet by discharge" includes a specific
distance and timeframe. Option B lacks a timeframe and measurability. Option C is
unrealistic (pain-free). Option D is a nursing intervention, not a patient outcome .
---
**Q3. What is the primary purpose of the assessment phase of the nursing process?**
A) It allows the nurse to administer medications
B) It provides data collection for identifying patient problems
C) It is the final step of the nursing process
D) It replaces the need for physician evaluation
**Correct Answer: B**
**Rationale:** The assessment phase involves systematic data collection (objective and
subjective) that forms the foundation for identifying nursing diagnoses, planning care,
implementing interventions, and evaluating outcomes .
---
,**Q4. What is the primary source of information during a nursing assessment?**
A) The patient's family
B) The patient's medical records
C) The patient
D) The healthcare provider
**Correct Answer: C**
**Rationale:** The patient is the primary source of information during a nursing
assessment. The primary source provides the most accurate subjective data about
symptoms, concerns, and health history. If the patient is confused, disoriented, or unable
to communicate, the family becomes the secondary source .
---
**Q5. What is the first thing the nurse should do when assessing a patient?**
A) Auscultate breath sounds
B) Palpate for tenderness
C) Observe the patient's appearance and behavior
D) Percuss for organ density
**Correct Answer: C**
, **Rationale:** Assessment begins with observation of the patient's overall appearance,
behavior, and general condition before proceeding to more focused physical
examination techniques (auscultation, palpation, percussion) .
---
**Q6. What part of the stethoscope is used to detect low-frequency sounds such as
abnormal heart sounds?**
A) The diaphragm
B) The bell
C) The earpieces
D) The chest piece
**Correct Answer: B**
**Rationale:** The bell of the stethoscope is used to detect low-frequency sounds such
as abnormal heart sounds (S3, S4, murmurs) and adventitious breath sounds. The
diaphragm is used for high-pitched sounds including normal heart, lung, and bowel
sounds .
---
**Q7. Where is the apical pulse located?**
A) 2nd intercostal space, midclavicular line
B) 5th intercostal space, midclavicular line
C) 4th intercostal space, sternal border
300 Practice Questions with Verified Answers
## SECTION 1: NURSING PROCESS, ASSESSMENT & DOCUMENTATION
(Questions 1-50)
**Q1. A nurse is caring for a client who has a new diagnosis of diabetes mellitus. What is
the first action the nurse should take?**
A) Administer insulin as prescribed
B) Check the client's blood glucose level
C) Teach the client how to use a glucometer
D) Evaluate the effectiveness of dietary changes
**Correct Answer: B**
**Rationale:** Assessment is the first phase of the nursing process and involves
collecting objective and subjective data. Checking blood glucose is a data collection
activity. Administration and teaching are implementation activities, and evaluation is the
final step of the nursing process .
---
**Q2. A nurse is planning care for a client who is post-operative following a hip
replacement. Which of the following outcomes is correctly written?**
A) "The client will walk 50 feet by discharge"
,B) "The client will ambulate independently"
C) "The client will be pain-free"
D) "The nurse will assist the client with walking"
**Correct Answer: A**
**Rationale:** A correctly written outcome is specific, measurable, achievable, realistic,
and time-bound (SMART). "The client will walk 50 feet by discharge" includes a specific
distance and timeframe. Option B lacks a timeframe and measurability. Option C is
unrealistic (pain-free). Option D is a nursing intervention, not a patient outcome .
---
**Q3. What is the primary purpose of the assessment phase of the nursing process?**
A) It allows the nurse to administer medications
B) It provides data collection for identifying patient problems
C) It is the final step of the nursing process
D) It replaces the need for physician evaluation
**Correct Answer: B**
**Rationale:** The assessment phase involves systematic data collection (objective and
subjective) that forms the foundation for identifying nursing diagnoses, planning care,
implementing interventions, and evaluating outcomes .
---
,**Q4. What is the primary source of information during a nursing assessment?**
A) The patient's family
B) The patient's medical records
C) The patient
D) The healthcare provider
**Correct Answer: C**
**Rationale:** The patient is the primary source of information during a nursing
assessment. The primary source provides the most accurate subjective data about
symptoms, concerns, and health history. If the patient is confused, disoriented, or unable
to communicate, the family becomes the secondary source .
---
**Q5. What is the first thing the nurse should do when assessing a patient?**
A) Auscultate breath sounds
B) Palpate for tenderness
C) Observe the patient's appearance and behavior
D) Percuss for organ density
**Correct Answer: C**
, **Rationale:** Assessment begins with observation of the patient's overall appearance,
behavior, and general condition before proceeding to more focused physical
examination techniques (auscultation, palpation, percussion) .
---
**Q6. What part of the stethoscope is used to detect low-frequency sounds such as
abnormal heart sounds?**
A) The diaphragm
B) The bell
C) The earpieces
D) The chest piece
**Correct Answer: B**
**Rationale:** The bell of the stethoscope is used to detect low-frequency sounds such
as abnormal heart sounds (S3, S4, murmurs) and adventitious breath sounds. The
diaphragm is used for high-pitched sounds including normal heart, lung, and bowel
sounds .
---
**Q7. Where is the apical pulse located?**
A) 2nd intercostal space, midclavicular line
B) 5th intercostal space, midclavicular line
C) 4th intercostal space, sternal border
