Basic Nursing Skills: 150 Advanced Multiple-Choice
Questions with Rationales
Difficulty Level: Advanced / Hard / Mixed
Target Audience: Nursing students (BSN/ADN), NCLEX-RN candidates, and practicing nurses seeking
certification review
Table of Contents
1. Vital Signs and Physical Assessment (Questions 1–25)
2. Infection Control and Prevention (Questions 26–50)
3. Medication Administration and Dosage Calculation (Questions 51–75)
4. Wound Care and Pressure Injury Management (Questions 76–95)
5. Patient Safety and Risk Management (Questions 96–115)
6. Nursing Documentation and Legal-Ethical Considerations (Questions 116–130)
7. Fundamental Nursing Interventions and Patient Care (Questions 131–150)
8. Answer Key with Rationales
9. References
Section 1: Vital Signs and Physical Assessment (Questions 1–25)
🟢 1. A nurse is measuring a patient's blood pressure and finds the cuff is too small for the patient's arm.
What effect will this have on the reading?
A) The reading will be falsely low
B) The reading will not be affected
C) The reading will be falsely high
D) The diastolic pressure will be low and systolic will be high
🔴🔴 Correct Answer: C
Rationale: A blood pressure cuff that is too narrow or small will result in a falsely high blood pressure
reading because the cuff must be inflated more to occlude the artery. Conversely, a cuff that is too wide
will result in a falsely low reading. Using the correct cuff size is essential for accurate blood pressure
measurement.
🟢 2. Where is the apical pulse located in an adult patient?
,A) Second intercostal space, right sternal border
B) Fourth intercostal space, left sternal border
C) Third intercostal space, midaxillary line
D) Fifth intercostal space, left midclavicular line
🔴🔴 Correct Answer: D
Rationale: The apical pulse is located at the apex of the heart, which is found at the fifth intercostal
space at the left midclavicular line. This is the point of maximal impulse (PMI) and is used for accurate
assessment of heart rate and rhythm, particularly in patients with irregular pulses.
🟢 3. Which one of the following indicates a tachycardia?
A) Less than 60 beats per minute
B) More than 60 beats per minute
C) Less than 120 beats per minute
D) More than 120 beats per minute
🔴🔴 Correct Answer: D
Rationale: Tachycardia is defined as a heart rate exceeding 120 beats per minute in adults. Bradycardia
is a heart rate below 60 beats per minute. Normal adult heart rate ranges from 60 to 100 beats per
minute.
🟢 4. Which one of the following blood pressure readings would indicate a patient is hypertensive?
A) 140/90 mmHg
B) 90/140 mmHg
C) 90/60 mmHg
D) 60/90 mmHg
🔴🔴 Correct Answer: A
Rationale: A blood pressure reading of 140/90 mmHg or higher is classified as hypertension. The systolic
pressure is the top number and diastolic is the bottom number. Reading 90/140 is not physiologically
accurate as diastolic cannot exceed systolic in standard measurement.
🟢 5. Which one of the following blood pressure recordings would indicate that a patient is hypotensive?
A) 140/90 mmHg
B) 90/140 mmHg
C) 90/60 mmHg
D) 60/90 mmHg
🔴🔴 Correct Answer: C
Rationale: Hypotension is generally defined as a blood pressure reading below 90/60 mmHg. This
,indicates inadequate perfusion pressure and may require immediate nursing intervention and provider
notification.
🟢 6. What is pyrexia?
A) A high blood pressure
B) A high pulse rate
C) A high temperature
D) A high respiratory rate
🔴🔴 Correct Answer: C
Rationale: Pyrexia is the medical term for an elevated body temperature, commonly known as fever. It
is a sign of an underlying inflammatory or infectious process and requires monitoring and appropriate
nursing intervention.
🟢 7. Which one of the following is a sign of oral thrush?
A) Bleeding gums
B) White spots in oral cavity
C) Tooth decay
D) Red spots in oral cavity
🔴🔴 Correct Answer: B
Rationale: Oral thrush (candidiasis) presents with characteristic white, curd-like patches on the oral
mucosa, tongue, and pharynx. These lesions may bleed when scraped and are commonly seen in
immunocompromised patients, those on antibiotics, or patients receiving inhaled corticosteroids.
🟢 8. Which of the following is considered a subjective assessment finding?
A) Blood pressure 140/90 mmHg
B) Patient reports "I feel dizzy"
C) Respiratory rate of 22 breaths per minute
D) Skin warm and dry to the touch
🔴🔴 Correct Answer: B
Rationale: Subjective data are information from the patient's point of view, including feelings,
perceptions, and concerns that cannot be objectively measured. Blood pressure, respiratory rate, and
skin temperature are objective data that can be observed and measured.
🟢 9. Which patient would require follow-up based on respiratory rate?
A) An adolescent with a respiratory rate of 16 breaths per minute
B) A child with a respiratory rate of 20 breaths per minute
, C) A newborn with a respiratory rate of 40 breaths per minute
D) An adult with a respiratory rate of 10 breaths per minute
🔴🔴 Correct Answer: D
Rationale: An adult with a respiratory rate of 10 breaths per minute is bradypneic and would require
follow-up. Normal adult respiratory rate is 12–20 breaths per minute. Adolescents, children, and
newborns have different normal ranges.
🟢 10. Which of the following vital signs recorded for an older adult would be considered acceptable
(within normal limits)?
A) Temp 98.6°F, P-56, R-20, BP 120/80, O2 sat 91%
B) Temp 97.0°F, P-60, R-16, BP 116/78, O2 sat 95%
C) Temp 96.8°F, P-60, R-18, BP 160/90, O2 sat 93%
D) Temp 98.0°F, P-76, R-22, BP 110/70, O2 sat 88%
🔴🔴 Correct Answer: B
Rationale: For an older adult, acceptable vital signs include temperature 97.0°F, pulse 60, respiratory
rate 16, blood pressure 116/78, and O2 saturation 95%. Option A has a pulse of 56 (bradycardia), Option
C has elevated blood pressure, and Option D has O2 saturation of 88% (hypoxemia) and tachypnea.
🟢 11. A nurse is assessing a client's pulse and finds it to be irregular. Which action should the nurse take
next?
A) Document the finding as a normal variant
B) Count the radial pulse for 15 seconds and multiply by 4
C) Assess the apical pulse for a full minute
D) Recheck the pulse in 4 hours
🔴🔴 Correct Answer: C
Rationale: When an irregular pulse is detected, the nurse should assess the apical pulse for a full minute
to obtain an accurate heart rate and rhythm assessment. A 15-second count is insufficient for irregular
rhythms and may lead to inaccurate documentation. Apical assessment provides the most accurate
measurement of cardiac rate and rhythm.
🟢 12. When performing hand hygiene with soap and water, how long should the nurse scrub their
hands?
A) At least 5 seconds
B) At least 20 seconds
C) At least 10 seconds
D) At least 1 minute
Questions with Rationales
Difficulty Level: Advanced / Hard / Mixed
Target Audience: Nursing students (BSN/ADN), NCLEX-RN candidates, and practicing nurses seeking
certification review
Table of Contents
1. Vital Signs and Physical Assessment (Questions 1–25)
2. Infection Control and Prevention (Questions 26–50)
3. Medication Administration and Dosage Calculation (Questions 51–75)
4. Wound Care and Pressure Injury Management (Questions 76–95)
5. Patient Safety and Risk Management (Questions 96–115)
6. Nursing Documentation and Legal-Ethical Considerations (Questions 116–130)
7. Fundamental Nursing Interventions and Patient Care (Questions 131–150)
8. Answer Key with Rationales
9. References
Section 1: Vital Signs and Physical Assessment (Questions 1–25)
🟢 1. A nurse is measuring a patient's blood pressure and finds the cuff is too small for the patient's arm.
What effect will this have on the reading?
A) The reading will be falsely low
B) The reading will not be affected
C) The reading will be falsely high
D) The diastolic pressure will be low and systolic will be high
🔴🔴 Correct Answer: C
Rationale: A blood pressure cuff that is too narrow or small will result in a falsely high blood pressure
reading because the cuff must be inflated more to occlude the artery. Conversely, a cuff that is too wide
will result in a falsely low reading. Using the correct cuff size is essential for accurate blood pressure
measurement.
🟢 2. Where is the apical pulse located in an adult patient?
,A) Second intercostal space, right sternal border
B) Fourth intercostal space, left sternal border
C) Third intercostal space, midaxillary line
D) Fifth intercostal space, left midclavicular line
🔴🔴 Correct Answer: D
Rationale: The apical pulse is located at the apex of the heart, which is found at the fifth intercostal
space at the left midclavicular line. This is the point of maximal impulse (PMI) and is used for accurate
assessment of heart rate and rhythm, particularly in patients with irregular pulses.
🟢 3. Which one of the following indicates a tachycardia?
A) Less than 60 beats per minute
B) More than 60 beats per minute
C) Less than 120 beats per minute
D) More than 120 beats per minute
🔴🔴 Correct Answer: D
Rationale: Tachycardia is defined as a heart rate exceeding 120 beats per minute in adults. Bradycardia
is a heart rate below 60 beats per minute. Normal adult heart rate ranges from 60 to 100 beats per
minute.
🟢 4. Which one of the following blood pressure readings would indicate a patient is hypertensive?
A) 140/90 mmHg
B) 90/140 mmHg
C) 90/60 mmHg
D) 60/90 mmHg
🔴🔴 Correct Answer: A
Rationale: A blood pressure reading of 140/90 mmHg or higher is classified as hypertension. The systolic
pressure is the top number and diastolic is the bottom number. Reading 90/140 is not physiologically
accurate as diastolic cannot exceed systolic in standard measurement.
🟢 5. Which one of the following blood pressure recordings would indicate that a patient is hypotensive?
A) 140/90 mmHg
B) 90/140 mmHg
C) 90/60 mmHg
D) 60/90 mmHg
🔴🔴 Correct Answer: C
Rationale: Hypotension is generally defined as a blood pressure reading below 90/60 mmHg. This
,indicates inadequate perfusion pressure and may require immediate nursing intervention and provider
notification.
🟢 6. What is pyrexia?
A) A high blood pressure
B) A high pulse rate
C) A high temperature
D) A high respiratory rate
🔴🔴 Correct Answer: C
Rationale: Pyrexia is the medical term for an elevated body temperature, commonly known as fever. It
is a sign of an underlying inflammatory or infectious process and requires monitoring and appropriate
nursing intervention.
🟢 7. Which one of the following is a sign of oral thrush?
A) Bleeding gums
B) White spots in oral cavity
C) Tooth decay
D) Red spots in oral cavity
🔴🔴 Correct Answer: B
Rationale: Oral thrush (candidiasis) presents with characteristic white, curd-like patches on the oral
mucosa, tongue, and pharynx. These lesions may bleed when scraped and are commonly seen in
immunocompromised patients, those on antibiotics, or patients receiving inhaled corticosteroids.
🟢 8. Which of the following is considered a subjective assessment finding?
A) Blood pressure 140/90 mmHg
B) Patient reports "I feel dizzy"
C) Respiratory rate of 22 breaths per minute
D) Skin warm and dry to the touch
🔴🔴 Correct Answer: B
Rationale: Subjective data are information from the patient's point of view, including feelings,
perceptions, and concerns that cannot be objectively measured. Blood pressure, respiratory rate, and
skin temperature are objective data that can be observed and measured.
🟢 9. Which patient would require follow-up based on respiratory rate?
A) An adolescent with a respiratory rate of 16 breaths per minute
B) A child with a respiratory rate of 20 breaths per minute
, C) A newborn with a respiratory rate of 40 breaths per minute
D) An adult with a respiratory rate of 10 breaths per minute
🔴🔴 Correct Answer: D
Rationale: An adult with a respiratory rate of 10 breaths per minute is bradypneic and would require
follow-up. Normal adult respiratory rate is 12–20 breaths per minute. Adolescents, children, and
newborns have different normal ranges.
🟢 10. Which of the following vital signs recorded for an older adult would be considered acceptable
(within normal limits)?
A) Temp 98.6°F, P-56, R-20, BP 120/80, O2 sat 91%
B) Temp 97.0°F, P-60, R-16, BP 116/78, O2 sat 95%
C) Temp 96.8°F, P-60, R-18, BP 160/90, O2 sat 93%
D) Temp 98.0°F, P-76, R-22, BP 110/70, O2 sat 88%
🔴🔴 Correct Answer: B
Rationale: For an older adult, acceptable vital signs include temperature 97.0°F, pulse 60, respiratory
rate 16, blood pressure 116/78, and O2 saturation 95%. Option A has a pulse of 56 (bradycardia), Option
C has elevated blood pressure, and Option D has O2 saturation of 88% (hypoxemia) and tachypnea.
🟢 11. A nurse is assessing a client's pulse and finds it to be irregular. Which action should the nurse take
next?
A) Document the finding as a normal variant
B) Count the radial pulse for 15 seconds and multiply by 4
C) Assess the apical pulse for a full minute
D) Recheck the pulse in 4 hours
🔴🔴 Correct Answer: C
Rationale: When an irregular pulse is detected, the nurse should assess the apical pulse for a full minute
to obtain an accurate heart rate and rhythm assessment. A 15-second count is insufficient for irregular
rhythms and may lead to inaccurate documentation. Apical assessment provides the most accurate
measurement of cardiac rate and rhythm.
🟢 12. When performing hand hygiene with soap and water, how long should the nurse scrub their
hands?
A) At least 5 seconds
B) At least 20 seconds
C) At least 10 seconds
D) At least 1 minute
