EXAM PRACTICE – QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
|2026 Q&A | INSTANT DOWNLOAD PDF
1. A nurse is assessing a patient’s blood pressure. Which factor would most
likely increase blood pressure?
A. Hemorrhage
B. Stress
C. Dehydration
D. Vasodilation
Answer: B. Stress
Rationale: Stress activates the sympathetic nervous system, increasing heart rate
and vasoconstriction, which raises blood pressure. Hemorrhage and dehydration
lower BP, while vasodilation decreases it.
2. The nurse is preparing to administer a subcutaneous injection. Which needle
size is most appropriate?
A. 18-gauge, 1 ½ inch
B. 20-gauge, 1 inch
C. 25-gauge, 5/8 inch
D. 22-gauge, 1 ½ inch
Answer: C. 25-gauge, 5/8 inch
Rationale: A 25-gauge, 5/8 inch needle is recommended for subcutaneous
injections. Larger needles like 18- or 20-gauge are for IM or IV use.
3. Which of the following is an example of a subjective assessment finding?
,A. Pulse rate of 92 bpm
B. Blood pressure of 120/80 mmHg
C. Patient reports dizziness
D. Temperature of 99.1°F
Answer: C. Patient reports dizziness
Rationale: Subjective data comes directly from the patient’s description, like
dizziness. Objective data is measurable, like vital signs.
4. The nurse is providing education about hand hygiene. Which statement
indicates correct understanding?
A. "I should wash my hands for at least 10 seconds."
B. "I should scrub my hands for at least 20 seconds."
C. "I only need to wash with water if my hands look clean."
D. "Hand sanitizer replaces hand washing in all cases."
Answer: B. "I should scrub my hands for at least 20 seconds."
Rationale: The CDC recommends washing hands with soap and water for at least
20 seconds to effectively remove pathogens.
5. A patient on strict bed rest is at greatest risk for which complication?
A. Hypoglycemia
B. Hypertension
C. Pressure injuries
D. Diarrhea
Answer: C. Pressure injuries
Rationale: Immobility leads to prolonged pressure on skin, causing ischemia and
tissue breakdown, resulting in pressure injuries.
6. The nurse is prioritizing care using Maslow's hierarchy of needs. Which action
should take priority?
,A. Teaching about a new diet plan
B. Administering oxygen to a hypoxic patient
C. Discussing coping strategies
D. Providing information about medications
Answer: B. Administering oxygen to a hypoxic patient
Rationale: Physiological needs, such as oxygenation, take priority before
psychological or educational needs.
7. The nurse recognizes that which situation represents a breach of patient
confidentiality?
A. Documenting care in the patient’s chart
B. Discussing a patient’s diagnosis in a public hallway
C. Communicating with the healthcare team in a private room
D. Using secure electronic health records
Answer: B. Discussing a patient’s diagnosis in a public hallway
Rationale: Patient information must remain private; discussing it in public violates
HIPAA.
8. The nurse is preparing to insert a Foley catheter. Which step should be
performed first?
A. Lubricate the catheter tip
B. Perform hand hygiene
C. Inflate the balloon
D. Position the drainage bag
Answer: B. Perform hand hygiene
Rationale: Hand hygiene prevents infection and is always performed before any
sterile procedure.
9. Which intervention best prevents urinary tract infections in catheterized
patients?
, A. Change the catheter daily
B. Maintain a closed drainage system
C. Clean the catheter insertion site with soap and water only once a week
D. Keep the drainage bag above the bladder level
Answer: B. Maintain a closed drainage system
Rationale: A closed system reduces the risk of introducing bacteria into the urinary
tract.
10. Which assessment finding should the nurse report immediately?
A. Temperature of 99.2°F
B. Respirations of 18 per minute
C. Blood pressure of 122/76 mmHg
D. Respirations of 8 per minute
Answer: D. Respirations of 8 per minute
Rationale: Normal respirations are 12–20 per minute. A rate of 8 indicates
respiratory depression and requires urgent intervention.
11. Which position is best for a patient experiencing shortness of breath?
A. Supine
B. High Fowler’s
C. Trendelenburg
D. Prone
Answer: B. High Fowler’s
Rationale: Sitting upright promotes lung expansion and eases breathing.
12. Which action demonstrates proper use of a gait belt?
A. Placing it loosely so it can be easily removed
B. Securing it snugly around the patient’s waist
C. Positioning it below the hips
D. Tying it in a bow at the front