NURS101 Proctored Exam Questions With
Complete Answers
A nurse is caring for a client who ingested a poison and is now experiencing a seizure.
Which of the following is the priority action the nurse should take?
a. Check the patency of the client's airway
b. Determine the poison that was ingested
c. Identify the amount of poison that was ingested
d. Position the client side-lying. - ANSWER a. Check the patency of the client's airway
The priority action the nurse should take when using the airway, breathing, circulation
(ABC) approach to client care is checking the patency of the client's airway.
A nurse is admitting a client who reports anorexia and is experiencing malnutrition.
Which of the following laboratory findings should the nurse expect to be altered?
a. Creatine kinase
b. Troponin
c. Total bilirubin
d. Albumin - ANSWER D. Albumin
A low albumin is a measure of plasma proteins which reflects the nutritional condition of
a client experiencing anorexia and malnutrition over an extended period of time
A nurse is planning care for an older adult client who is at risk for developing pressure
ulcers. Which of the following interventions should the nurse use help maintain the
integrity of the client's skin?
a. Use a transfer device to lift the client up in bed.
b. Apply cornstarch to keep sensitive skin areas dry
,c. Massage the skin over the client's bony prominences
d. Elevate the head of the bed no more than 45 degrees - ANSWER a. Use a transfer
device to life the client up in bed
Using a lifting device prevents dragging the client's skin across the bed linens, which
can cause abrasions.
A nurse is orienting a new assistive personnel (AP) to the unit. For which of the following
actions should the nurse intervene?
a. Wears a gown when entering the room of a client who requires contact precautions
b. Dons gloves to empty a urinary drainage device
c. Washes and rinses her hands for 10 seconds
d. Wears a respirator mask when entering the room of a client who requires airborne
precautions - ANSWER c. Washes and rinses her hands for 10 seconds
The nurse should intervene because the AP should wash her hands for a least 20
seconds.
A nurse is assessing a client's bowel sounds. At which of the following points in the
assessment should the nurse auscultate the client's abdomen?
a. After palpating the abdomen
b. Prior to percussing the abdomen
c. After assessing for kidney tenderness
d. Prior to inspecting the abdomen - ANSWER b. Prior to percussing the abdomen
According to evidence-based practice, the nurse should auscultate the abdomen prior
to percussing it to prevent altering the bowel sounds. Both percussing and palpation
can stimulate the intestines, increase their motility, and intensify the bowel sounds
A nurse is filling out an incident report after finding a client lying on the floor. Which of
the following information should the nurse include?
,a. " The client attempted to climb over the side rails and fell"
b. "The client was lying on the floor next to his bed."
c. "the client was restless and trying to get out of bed all evening."
d. "The presence of a bed alarm could have prevented the client from falling." -
ANSWER B. "The client was lying on the floor next to his bed."
In an incident report, the nurse should only document what she actually witnessed,
along with the date, time, place, and any other actual facts about the incident.
A nurse is caring for a client who has a prescription for a stool test for guaiac. The nurse
understands the purpose of the test is to check the stool for which of the following
substances?
a. Steatorrhea
b. Blood
c. Bacteria
d. Parasites - ANSWER b. Blood
A guaiac test detects the presence of occult or hidden blood in the stool. The guaiac
test is an extremely useful diagnostic screening test for the presence of colon cancer
and gastrointestinal ulcers.
A charge nurse is anticipating the admission of four clients and planning their room
assignments. Which of the following clients should the nurses assign to the room closest
to the nurses station?
a. A client who sustained a head injury and is having periods of confusion
b. A client who reports a severe migraine headache
c. A client who has a suspected diagnosis of Tuberculosis (TB)
d. A client who has a history of atrial fibrillation and is on continuous ECG monitoring -
ANSWER a. A client who sustained a head injury and is having periods of confusion
A client who sustained a head injury and is confused is at risk for seizures. The nurse
, should place this client in a room near the nurses' station so that he can be closely
monitored to prevent injury if a seizure occurs.
A nurse is caring for a client who requires droplet precautions. Which of the following
personal protective equipment should the nurse wear when setting up the client's meal
tray?
a. Gloves
b. Goggles
c. Gown
d. Mask - ANSWER D. Mask
A nurse should follow droplet precautions for clients who have infections that spread by
droplets larger than 5 microns. The nurse should wear a mask whenever she is within
1m (3ft) of the client.
A nurse is caring for an older adult client who was alert and oriented at admission but
now seems increasingly restless and intermittently confused. Which of the following
actions should the nurse take to address the client's safety needs?
a. Call the family and ask them to stay with the client
b. Move the client to a room closer to the nurse's station
c. Apply wrist and leg restraints to the client
d. Administer medication to sedate the client. - ANSWER b. Move the client to a room
closer to the nurse's station
This will make it easier for the staff to observe the client, should the client behave in an
unsafe manner.
A nurse is preparing to administer an ophthalmic solution to a client. Which of the
following actions should the nurse take?
a. Instill the drops into the inner canthus
b. Approach the client's eye from below it
Complete Answers
A nurse is caring for a client who ingested a poison and is now experiencing a seizure.
Which of the following is the priority action the nurse should take?
a. Check the patency of the client's airway
b. Determine the poison that was ingested
c. Identify the amount of poison that was ingested
d. Position the client side-lying. - ANSWER a. Check the patency of the client's airway
The priority action the nurse should take when using the airway, breathing, circulation
(ABC) approach to client care is checking the patency of the client's airway.
A nurse is admitting a client who reports anorexia and is experiencing malnutrition.
Which of the following laboratory findings should the nurse expect to be altered?
a. Creatine kinase
b. Troponin
c. Total bilirubin
d. Albumin - ANSWER D. Albumin
A low albumin is a measure of plasma proteins which reflects the nutritional condition of
a client experiencing anorexia and malnutrition over an extended period of time
A nurse is planning care for an older adult client who is at risk for developing pressure
ulcers. Which of the following interventions should the nurse use help maintain the
integrity of the client's skin?
a. Use a transfer device to lift the client up in bed.
b. Apply cornstarch to keep sensitive skin areas dry
,c. Massage the skin over the client's bony prominences
d. Elevate the head of the bed no more than 45 degrees - ANSWER a. Use a transfer
device to life the client up in bed
Using a lifting device prevents dragging the client's skin across the bed linens, which
can cause abrasions.
A nurse is orienting a new assistive personnel (AP) to the unit. For which of the following
actions should the nurse intervene?
a. Wears a gown when entering the room of a client who requires contact precautions
b. Dons gloves to empty a urinary drainage device
c. Washes and rinses her hands for 10 seconds
d. Wears a respirator mask when entering the room of a client who requires airborne
precautions - ANSWER c. Washes and rinses her hands for 10 seconds
The nurse should intervene because the AP should wash her hands for a least 20
seconds.
A nurse is assessing a client's bowel sounds. At which of the following points in the
assessment should the nurse auscultate the client's abdomen?
a. After palpating the abdomen
b. Prior to percussing the abdomen
c. After assessing for kidney tenderness
d. Prior to inspecting the abdomen - ANSWER b. Prior to percussing the abdomen
According to evidence-based practice, the nurse should auscultate the abdomen prior
to percussing it to prevent altering the bowel sounds. Both percussing and palpation
can stimulate the intestines, increase their motility, and intensify the bowel sounds
A nurse is filling out an incident report after finding a client lying on the floor. Which of
the following information should the nurse include?
,a. " The client attempted to climb over the side rails and fell"
b. "The client was lying on the floor next to his bed."
c. "the client was restless and trying to get out of bed all evening."
d. "The presence of a bed alarm could have prevented the client from falling." -
ANSWER B. "The client was lying on the floor next to his bed."
In an incident report, the nurse should only document what she actually witnessed,
along with the date, time, place, and any other actual facts about the incident.
A nurse is caring for a client who has a prescription for a stool test for guaiac. The nurse
understands the purpose of the test is to check the stool for which of the following
substances?
a. Steatorrhea
b. Blood
c. Bacteria
d. Parasites - ANSWER b. Blood
A guaiac test detects the presence of occult or hidden blood in the stool. The guaiac
test is an extremely useful diagnostic screening test for the presence of colon cancer
and gastrointestinal ulcers.
A charge nurse is anticipating the admission of four clients and planning their room
assignments. Which of the following clients should the nurses assign to the room closest
to the nurses station?
a. A client who sustained a head injury and is having periods of confusion
b. A client who reports a severe migraine headache
c. A client who has a suspected diagnosis of Tuberculosis (TB)
d. A client who has a history of atrial fibrillation and is on continuous ECG monitoring -
ANSWER a. A client who sustained a head injury and is having periods of confusion
A client who sustained a head injury and is confused is at risk for seizures. The nurse
, should place this client in a room near the nurses' station so that he can be closely
monitored to prevent injury if a seizure occurs.
A nurse is caring for a client who requires droplet precautions. Which of the following
personal protective equipment should the nurse wear when setting up the client's meal
tray?
a. Gloves
b. Goggles
c. Gown
d. Mask - ANSWER D. Mask
A nurse should follow droplet precautions for clients who have infections that spread by
droplets larger than 5 microns. The nurse should wear a mask whenever she is within
1m (3ft) of the client.
A nurse is caring for an older adult client who was alert and oriented at admission but
now seems increasingly restless and intermittently confused. Which of the following
actions should the nurse take to address the client's safety needs?
a. Call the family and ask them to stay with the client
b. Move the client to a room closer to the nurse's station
c. Apply wrist and leg restraints to the client
d. Administer medication to sedate the client. - ANSWER b. Move the client to a room
closer to the nurse's station
This will make it easier for the staff to observe the client, should the client behave in an
unsafe manner.
A nurse is preparing to administer an ophthalmic solution to a client. Which of the
following actions should the nurse take?
a. Instill the drops into the inner canthus
b. Approach the client's eye from below it
