BSN206 Exam 1 Actual Exam Style V3 |
BSN 206 Foundations of Nursing
Fundamentals Exam | Nightingale
Hallmark ISB
1. A nurse is performing a physical assessment on a newly admitted patient. Which step of
the nursing process is the nurse currently engaged in?
A. Diagnosis
B. Planning
C. Implementation
D. Assessment
Answer: D
Rationale: Assessment is the first step of the nursing process involving the systematic
collection of data. This stage includes both subjective and objective data gathering to
establish a baseline for patient care. It is essential for identifying the patient’s health needs
before moving to the diagnosis stage.
2. According to Maslow’s Hierarchy of Needs, which of the following patient needs should the
nurse address first?
A. Adequate nutrition and hydration
B. Protection from environmental hazards
,C. Self-esteem and recognition
D. Love and belongingness
Answer: A
Rationale: Maslow’s hierarchy prioritizes physiological needs such as air, water, and food
above all others. These are foundational for survival and must be met before the patient
can focus on safety or social needs. Addressing these first ensures the patient’s physical
stability.
3. A nurse is preparing to wash their hands. Which action is the most important for
preventing the spread of microorganisms?
A. Using hot water to kill bacteria
B. Friction during rubbing of hands
C. Using a sterile towel to dry hands
D. Applying antibacterial lotion after washing
Answer: B
Rationale: Friction is the most effective component of handwashing for removing transient
flora and microorganisms. It physically breaks down the biofilm and dislodges dirt from the
skin surface. The CDC recommends scrubbing for at least 20 seconds to be effective.
, 4. A patient reports feeling dizzy and lightheaded when standing up. What should the nurse
assess for?
A. Hypertension
B. Orthostatic hypotension
C. Bradycardia
D. Hypothermia
Answer: B
Rationale: Orthostatic hypotension is a drop in blood pressure that occurs when a person
moves from a lying or sitting position to standing. This condition often results in dizziness
or syncope due to reduced cerebral perfusion. Nurses should measure blood pressure in
multiple positions to confirm this diagnosis.
5. Which therapeutic communication technique is the nurse using when saying, ‘Tell me more
about how you are feeling’?
A. Summarizing
B. Exploring
C. Giving advice
D. Challenging
Answer: B
BSN 206 Foundations of Nursing
Fundamentals Exam | Nightingale
Hallmark ISB
1. A nurse is performing a physical assessment on a newly admitted patient. Which step of
the nursing process is the nurse currently engaged in?
A. Diagnosis
B. Planning
C. Implementation
D. Assessment
Answer: D
Rationale: Assessment is the first step of the nursing process involving the systematic
collection of data. This stage includes both subjective and objective data gathering to
establish a baseline for patient care. It is essential for identifying the patient’s health needs
before moving to the diagnosis stage.
2. According to Maslow’s Hierarchy of Needs, which of the following patient needs should the
nurse address first?
A. Adequate nutrition and hydration
B. Protection from environmental hazards
,C. Self-esteem and recognition
D. Love and belongingness
Answer: A
Rationale: Maslow’s hierarchy prioritizes physiological needs such as air, water, and food
above all others. These are foundational for survival and must be met before the patient
can focus on safety or social needs. Addressing these first ensures the patient’s physical
stability.
3. A nurse is preparing to wash their hands. Which action is the most important for
preventing the spread of microorganisms?
A. Using hot water to kill bacteria
B. Friction during rubbing of hands
C. Using a sterile towel to dry hands
D. Applying antibacterial lotion after washing
Answer: B
Rationale: Friction is the most effective component of handwashing for removing transient
flora and microorganisms. It physically breaks down the biofilm and dislodges dirt from the
skin surface. The CDC recommends scrubbing for at least 20 seconds to be effective.
, 4. A patient reports feeling dizzy and lightheaded when standing up. What should the nurse
assess for?
A. Hypertension
B. Orthostatic hypotension
C. Bradycardia
D. Hypothermia
Answer: B
Rationale: Orthostatic hypotension is a drop in blood pressure that occurs when a person
moves from a lying or sitting position to standing. This condition often results in dizziness
or syncope due to reduced cerebral perfusion. Nurses should measure blood pressure in
multiple positions to confirm this diagnosis.
5. Which therapeutic communication technique is the nurse using when saying, ‘Tell me more
about how you are feeling’?
A. Summarizing
B. Exploring
C. Giving advice
D. Challenging
Answer: B
