NUR 155 Foundations of Nursing
Exam 4 | Final Comprehensive Exam
2026/2027 (Newly Released
Q1: A nurse is discussing the code of ethics with a student. Which statement best describes the
principle of nonmaleficence?
A. The nurse's obligation to act in the patient's best interest.
B. The duty to do no harm. [CORRECT]
C. The patient's right to make their own decisions.
D. The fair distribution of healthcare resources.
Correct Answer: B
Rationale: Nonmaleficence is the ethical obligation to avoid causing harm to others.
Beneficence refers to acting in the patient's best interest, and Autonomy refers to the patient's
right to self-determination.
Q2: Which nursing action violates the patient's right to privacy?
A. Discussing the patient's condition in the hallway with the interdisciplinary team.
B. Sharing the patient's diagnosis with a transport volunteer who asks. [CORRECT]
C. Closing the door during a bedside shift report.
D. Asking the patient to sign a consent form before surgery.
Correct Answer: B
,Rationale: Sharing protected health information with individuals not involved in the patient's
care (like a volunteer) violates HIPAA and privacy rights. Discussions in the hallway should be
kept discreet but are often necessary for team communication; however, disclosing to
unnecessary personnel is a clear violation.
Q3: The nurse is documenting on the electronic health record (EHR). Which entry is most
appropriate?
A. "Patient is difficult and non-compliant."
B. "Patient refused to ambulate due to pain, stating, 'I hurt too much.'" [CORRECT]
C. "Patient seems sad today."
D. "Doctor rounded late."
Correct Answer: B
Rationale: Documentation should be objective, specific, and quote the patient when possible.
"Difficult" and "non-compliant" are judgmental labels. "Seems sad" is subjective. The doctor's
tardiness is not relevant to the patient's nursing care documentation.
Q4: A nurse observes a colleague making a medication error that does not harm the patient. The
colleague asks the nurse not to report it. The nurse should:
A. Respect the colleague's request and monitor the patient closely.
B. Report the error according to facility policy. [CORRECT]
C. Confront the colleague and threaten to report them if it happens again.
D. Ignore the error since no harm was done.
Correct Answer: B
Rationale: Nurses have an ethical and legal obligation to report errors to ensure patient safety
and system improvement. Covering up errors violates the standards of practice.
,Q5: Using the nursing process, the nurse "Evaluates" the patient's response to pain medication.
Which action is part of this phase?
A. Administering the prescribed analgesic.
B. Setting a goal that the patient's pain level will be below 3.
C. Asking the patient to rate their pain 30 minutes after medication. [CORRECT]
D. Assessing the patient's pain history.
Correct Answer: C
Rationale: Evaluation involves determining the patient's progress toward achieving the desired
outcome (pain relief). Asking for a pain rating after intervention measures the effectiveness of
the plan.
Q6: Which therapeutic communication technique is the nurse using when saying, "I hear you
saying that you are very anxious about the surgery tomorrow"?
A. Restating [CORRECT]
B. Focusing
C. Clarifying
D. Summarizing
Correct Answer: A
Rationale: Restating involves repeating the main idea of what the patient said to show
understanding and validate their feelings.
Q7: A patient is admitted with a suspected stroke. The nurse performs the Cincinnati Prehospital
Stroke Scale. Which assessment finding is NOT part of this scale?
A. Facial droop
B. Arm drift
C. Slurred speech
D. Blood pressure > 180/110 [CORRECT]
Correct Answer: D
, Rationale: The Cincinnati Prehospital Stroke Scale assesses three things: Facial droop, Arm
drift, and Speech (Slurred or inappropriate words). Blood pressure is part of the general
assessment but not the specific stroke scale screening tool.
Q8: The nurse is caring for a patient who speaks a different language. An interpreter is not
available. Which action is best?
A. Use a translation app on the nurse's phone.
B. Ask the patient's 12-year-old child to translate.
C. Use gestures and pictures to communicate. [CORRECT]
D. Delay care until an interpreter arrives.
Correct Answer: C
Rationale: In the absence of a certified interpreter, using gestures and pictures (visual aids) is the
best alternative to ensure basic communication and safety. Children should not be used due to
confidentiality and accuracy issues. Care cannot be delayed for emergency needs, and translation
apps may be unreliable for medical terms.
Q9: The nurse suspects that a child is being physically abused based on unexplained bruising.
What is the nurse's primary legal responsibility?
A. Confront the parents about the injuries.
B. Document the findings and report to Child Protective Services (CPS). [CORRECT]
C. Teach the parents about child safety.
D. Remove the child from the home immediately.
Correct Answer: B
Rationale: Nurses are mandated reporters. They must document objectively and report the
suspicion to the appropriate authorities (CPS). Confrontation can escalate danger, and nurses do
not have the legal authority to remove children from homes.
Exam 4 | Final Comprehensive Exam
2026/2027 (Newly Released
Q1: A nurse is discussing the code of ethics with a student. Which statement best describes the
principle of nonmaleficence?
A. The nurse's obligation to act in the patient's best interest.
B. The duty to do no harm. [CORRECT]
C. The patient's right to make their own decisions.
D. The fair distribution of healthcare resources.
Correct Answer: B
Rationale: Nonmaleficence is the ethical obligation to avoid causing harm to others.
Beneficence refers to acting in the patient's best interest, and Autonomy refers to the patient's
right to self-determination.
Q2: Which nursing action violates the patient's right to privacy?
A. Discussing the patient's condition in the hallway with the interdisciplinary team.
B. Sharing the patient's diagnosis with a transport volunteer who asks. [CORRECT]
C. Closing the door during a bedside shift report.
D. Asking the patient to sign a consent form before surgery.
Correct Answer: B
,Rationale: Sharing protected health information with individuals not involved in the patient's
care (like a volunteer) violates HIPAA and privacy rights. Discussions in the hallway should be
kept discreet but are often necessary for team communication; however, disclosing to
unnecessary personnel is a clear violation.
Q3: The nurse is documenting on the electronic health record (EHR). Which entry is most
appropriate?
A. "Patient is difficult and non-compliant."
B. "Patient refused to ambulate due to pain, stating, 'I hurt too much.'" [CORRECT]
C. "Patient seems sad today."
D. "Doctor rounded late."
Correct Answer: B
Rationale: Documentation should be objective, specific, and quote the patient when possible.
"Difficult" and "non-compliant" are judgmental labels. "Seems sad" is subjective. The doctor's
tardiness is not relevant to the patient's nursing care documentation.
Q4: A nurse observes a colleague making a medication error that does not harm the patient. The
colleague asks the nurse not to report it. The nurse should:
A. Respect the colleague's request and monitor the patient closely.
B. Report the error according to facility policy. [CORRECT]
C. Confront the colleague and threaten to report them if it happens again.
D. Ignore the error since no harm was done.
Correct Answer: B
Rationale: Nurses have an ethical and legal obligation to report errors to ensure patient safety
and system improvement. Covering up errors violates the standards of practice.
,Q5: Using the nursing process, the nurse "Evaluates" the patient's response to pain medication.
Which action is part of this phase?
A. Administering the prescribed analgesic.
B. Setting a goal that the patient's pain level will be below 3.
C. Asking the patient to rate their pain 30 minutes after medication. [CORRECT]
D. Assessing the patient's pain history.
Correct Answer: C
Rationale: Evaluation involves determining the patient's progress toward achieving the desired
outcome (pain relief). Asking for a pain rating after intervention measures the effectiveness of
the plan.
Q6: Which therapeutic communication technique is the nurse using when saying, "I hear you
saying that you are very anxious about the surgery tomorrow"?
A. Restating [CORRECT]
B. Focusing
C. Clarifying
D. Summarizing
Correct Answer: A
Rationale: Restating involves repeating the main idea of what the patient said to show
understanding and validate their feelings.
Q7: A patient is admitted with a suspected stroke. The nurse performs the Cincinnati Prehospital
Stroke Scale. Which assessment finding is NOT part of this scale?
A. Facial droop
B. Arm drift
C. Slurred speech
D. Blood pressure > 180/110 [CORRECT]
Correct Answer: D
, Rationale: The Cincinnati Prehospital Stroke Scale assesses three things: Facial droop, Arm
drift, and Speech (Slurred or inappropriate words). Blood pressure is part of the general
assessment but not the specific stroke scale screening tool.
Q8: The nurse is caring for a patient who speaks a different language. An interpreter is not
available. Which action is best?
A. Use a translation app on the nurse's phone.
B. Ask the patient's 12-year-old child to translate.
C. Use gestures and pictures to communicate. [CORRECT]
D. Delay care until an interpreter arrives.
Correct Answer: C
Rationale: In the absence of a certified interpreter, using gestures and pictures (visual aids) is the
best alternative to ensure basic communication and safety. Children should not be used due to
confidentiality and accuracy issues. Care cannot be delayed for emergency needs, and translation
apps may be unreliable for medical terms.
Q9: The nurse suspects that a child is being physically abused based on unexplained bruising.
What is the nurse's primary legal responsibility?
A. Confront the parents about the injuries.
B. Document the findings and report to Child Protective Services (CPS). [CORRECT]
C. Teach the parents about child safety.
D. Remove the child from the home immediately.
Correct Answer: B
Rationale: Nurses are mandated reporters. They must document objectively and report the
suspicion to the appropriate authorities (CPS). Confrontation can escalate danger, and nurses do
not have the legal authority to remove children from homes.
