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NURS 120 Assessment 3 Fall 2026 – 100 Actual
Questions & Answers (West Coast University)
Section 1: Nursing Process, Safety, and Legal/Ethical Issues
Questions 1–15
1. Which action by the nurse is the best example of maintaining patient
confidentiality?
A. Discussing patient information in the hallway
B. Sharing the patient’s diagnosis with a family member without permission
C. Logging off the computer when leaving the patient’s chart open
D. Posting patient photos on social media
Answer: C
Explanation: Logging off and protecting electronic records maintains
confidentiality. Sharing information without permission violates HIPAA.
2. The nurse is caring for a patient who refuses a prescribed blood draw. The
nurse should first:
A. Draw the blood anyway
B. Explain the purpose and respect the patient’s right to refuse
C. Restrain the patient
D. Ask the family to convince the patient
Answer: B
Explanation: Patients have the right to refuse treatment. The nurse should
provide education and respect the decision.
3. Which nursing diagnosis has the highest priority?
A. Impaired Skin Integrity
B. Ineffective Airway Clearance
pg. 1
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C. Disturbed Body Image
D. Deficient Knowledge
Answer: B
Explanation: Airway, breathing, and circulation (ABCs) always take priority.
4. A nurse is prioritizing care for four patients. Which patient should be seen
first?
A. A patient with a temperature of 99.8°F
B. A patient with new onset confusion and oxygen saturation of 88%
C. A patient requesting pain medication for mild pain
D. A patient scheduled for discharge teaching
Answer: B
Explanation: New confusion and hypoxemia may indicate an acute change
requiring immediate assessment.
5. The nurse is delegating tasks to an unlicensed assistive personnel (UAP).
Which task can be delegated?
A. Assessing a new admission
B. Taking vital signs and reporting abnormalities
C. Evaluating a patient’s response to medication
D. Developing a nursing care plan
Answer: B
Explanation: UAP can take vital signs, but assessment, evaluation, and care
planning are RN responsibilities.
6. A patient has a do-not-resuscitate (DNR) order. What does this mean?
A. No care should be provided
B. Cardiopulmonary resuscitation should not be performed if the patient’s heart
stops
C. All medications should be stopped
D. The patient cannot leave the hospital
pg. 2
,3
Answer: B
Explanation: DNR means CPR and advanced cardiac life support will not be
initiated if the heart or breathing stops. Other care continues.
7. Which action is required before performing any procedure on a patient?
A. Obtain informed consent except in emergencies
B. Restrain the patient
C. Administer pain medication
D. Call the family
Answer: A
Explanation: Informed consent is legally and ethically required before
procedures, except in life-threatening emergencies or when the patient lacks
capacity.
8. The nurse is documenting a patient’s pain. Which documentation is most
objective?
A. “Patient appears comfortable.”
B. “Patient reports pain 7/10 in the lower back.”
C. “Patient seems to be in a lot of pain.”
D. “Patient had a bad night.”
Answer: B
Explanation: Objective documentation includes measurable data such as pain
scale rating and location.
9. Which fall prevention intervention is most appropriate for an older adult?
A. Keep the bed in the highest position
B. Keep the call light within reach and bed in low position
C. Raise all four side rails at all times
D. Keep the room dark to promote sleep
pg. 3
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Answer: B
Explanation: A low bed and accessible call light reduce fall risk. Raising all side
rails can be considered a restraint.
10. The nurse is caring for a patient with a latex allergy. Which action is priority?
A. Use latex gloves
B. Ensure a latex-free environment and use nonlatex supplies
C. Apply lotion before gloves
D. Double glove
Answer: B
Explanation: Latex allergy requires strict avoidance of latex products to prevent
allergic reactions.
11. A patient is being admitted with suspected tuberculosis. Which isolation
precaution is required?
A. Contact
B. Droplet
C. Airborne
D. Standard only
Answer: C
Explanation: Tuberculosis requires airborne precautions, including a negative-
pressure room and N95 respirator.
12. The nurse is providing hand hygiene. Which action is most effective?
A. Using only water for 5 seconds
B. Using alcohol-based hand rub when hands are not visibly soiled
C. Wearing gloves instead of hand hygiene
D. Using the same gloves for multiple patients
Answer: B
Explanation: Alcohol-based hand rub is effective when hands are not visibly
soiled. Gloves do not replace hand hygiene.
pg. 4
NURS 120 Assessment 3 Fall 2026 – 100 Actual
Questions & Answers (West Coast University)
Section 1: Nursing Process, Safety, and Legal/Ethical Issues
Questions 1–15
1. Which action by the nurse is the best example of maintaining patient
confidentiality?
A. Discussing patient information in the hallway
B. Sharing the patient’s diagnosis with a family member without permission
C. Logging off the computer when leaving the patient’s chart open
D. Posting patient photos on social media
Answer: C
Explanation: Logging off and protecting electronic records maintains
confidentiality. Sharing information without permission violates HIPAA.
2. The nurse is caring for a patient who refuses a prescribed blood draw. The
nurse should first:
A. Draw the blood anyway
B. Explain the purpose and respect the patient’s right to refuse
C. Restrain the patient
D. Ask the family to convince the patient
Answer: B
Explanation: Patients have the right to refuse treatment. The nurse should
provide education and respect the decision.
3. Which nursing diagnosis has the highest priority?
A. Impaired Skin Integrity
B. Ineffective Airway Clearance
pg. 1
,2
C. Disturbed Body Image
D. Deficient Knowledge
Answer: B
Explanation: Airway, breathing, and circulation (ABCs) always take priority.
4. A nurse is prioritizing care for four patients. Which patient should be seen
first?
A. A patient with a temperature of 99.8°F
B. A patient with new onset confusion and oxygen saturation of 88%
C. A patient requesting pain medication for mild pain
D. A patient scheduled for discharge teaching
Answer: B
Explanation: New confusion and hypoxemia may indicate an acute change
requiring immediate assessment.
5. The nurse is delegating tasks to an unlicensed assistive personnel (UAP).
Which task can be delegated?
A. Assessing a new admission
B. Taking vital signs and reporting abnormalities
C. Evaluating a patient’s response to medication
D. Developing a nursing care plan
Answer: B
Explanation: UAP can take vital signs, but assessment, evaluation, and care
planning are RN responsibilities.
6. A patient has a do-not-resuscitate (DNR) order. What does this mean?
A. No care should be provided
B. Cardiopulmonary resuscitation should not be performed if the patient’s heart
stops
C. All medications should be stopped
D. The patient cannot leave the hospital
pg. 2
,3
Answer: B
Explanation: DNR means CPR and advanced cardiac life support will not be
initiated if the heart or breathing stops. Other care continues.
7. Which action is required before performing any procedure on a patient?
A. Obtain informed consent except in emergencies
B. Restrain the patient
C. Administer pain medication
D. Call the family
Answer: A
Explanation: Informed consent is legally and ethically required before
procedures, except in life-threatening emergencies or when the patient lacks
capacity.
8. The nurse is documenting a patient’s pain. Which documentation is most
objective?
A. “Patient appears comfortable.”
B. “Patient reports pain 7/10 in the lower back.”
C. “Patient seems to be in a lot of pain.”
D. “Patient had a bad night.”
Answer: B
Explanation: Objective documentation includes measurable data such as pain
scale rating and location.
9. Which fall prevention intervention is most appropriate for an older adult?
A. Keep the bed in the highest position
B. Keep the call light within reach and bed in low position
C. Raise all four side rails at all times
D. Keep the room dark to promote sleep
pg. 3
, 4
Answer: B
Explanation: A low bed and accessible call light reduce fall risk. Raising all side
rails can be considered a restraint.
10. The nurse is caring for a patient with a latex allergy. Which action is priority?
A. Use latex gloves
B. Ensure a latex-free environment and use nonlatex supplies
C. Apply lotion before gloves
D. Double glove
Answer: B
Explanation: Latex allergy requires strict avoidance of latex products to prevent
allergic reactions.
11. A patient is being admitted with suspected tuberculosis. Which isolation
precaution is required?
A. Contact
B. Droplet
C. Airborne
D. Standard only
Answer: C
Explanation: Tuberculosis requires airborne precautions, including a negative-
pressure room and N95 respirator.
12. The nurse is providing hand hygiene. Which action is most effective?
A. Using only water for 5 seconds
B. Using alcohol-based hand rub when hands are not visibly soiled
C. Wearing gloves instead of hand hygiene
D. Using the same gloves for multiple patients
Answer: B
Explanation: Alcohol-based hand rub is effective when hands are not visibly
soiled. Gloves do not replace hand hygiene.
pg. 4
