NURS 101L Fundamentals of Nursing Skills Lab Exam 1 Study Guide
2026 |WCU
1. When preparing to perform a physical assessment on a client, which
technique should the nurse perform first to ensure accurate data collection of
the abdomen?
A. Palpation
B. Inspection
C. Auscultation
D. Percussion
Answer: B
Rationale: For abdominal assessment, the order is Inspection, Auscultation, Percussion,
and then Palpation. This is to avoid altering bowel sounds through manipulation.
2. A nurse is caring for a patient with Clostridium difficile (C. diff). Which hand
hygiene method is mandatory after providing direct care?
A. Alcohol-based hand rub for 15 seconds
B. Washing with soap and water
C. Using a chlorhexidine gluconate (CHG) wipe
D. Rinsing with warm water only
Answer: B
Rationale: Alcohol-based rubs are ineffective against C. diff spores; physical scrubbing
with soap and water is required to mechanically remove the spores.
,3. When dawning Personal Protective Equipment (PPE) for a patient on Droplet
Precautions, what is the correct sequence?
A. Gloves, Goggles, Mask, Gown
B. Gown, Mask, Goggles, Gloves
C. Mask, Gown, Goggles, Gloves
D. Goggles, Mask, Gloves, Gown
Answer: B
Rationale: The standard donning sequence is Gown, then Mask/Respirator, then
Goggles/Face Shield, and finally Gloves.
4. The nurse is assessing a client’s blood pressure and uses a cuff that is too
narrow for the client’s arm. What is the likely result?
A. A falsely low systolic reading
B. Inability to auscultate Korotkoff sounds
C. No significant change in accuracy
D. A falsely high systolic and diastolic reading
Answer: D
Rationale: A cuff that is too small or too narrow will yield a falsely high blood pressure
reading because it requires more pressure to occlude the artery.
5. A nurse finds a pulse deficit of 12 beats per minute. How was this calculated?
A. Subtracting the carotid pulse from the radial pulse
B. Subtracting the radial pulse from the apical pulse
C. Adding the apical and radial pulses together
D. Subtracting the diastolic pressure from the systolic pressure
Answer: B
Rationale: Pulse deficit is the difference between the apical pulse (heard at the heart) and
the radial pulse (felt at the wrist) taken simultaneously.
, 6. A client is at high risk for falls. Which nursing intervention is the most
appropriate according to safety standards?
A. Keep all four side rails in the up position
B. Administer a sedative to ensure the client stays in bed
C. Place the bed in the lowest position with wheels locked
D. Apply soft wrist restraints immediately
Answer: C
Rationale: Keeping the bed low and locked is a primary safety intervention. Four side rails
are considered a restraint, which requires a specific order.
7. What is the correct order for doffing (removing) PPE?
A. Mask, Gown, Goggles, Gloves
B. Gloves, Goggles, Gown, Mask
C. Gown, Gloves, Mask, Goggles
D. Gloves, Gown, Goggles, Mask
Answer: B
Rationale: The standard doffing sequence is Gloves, then Goggles/Face Shield, then Gown,
and finally the Mask (if not using an alternative protocol where gown/gloves are removed
together).
8. The nurse is performing a skin assessment. Which finding indicates the need
for immediate intervention regarding oxygenation?
A. Skin turgor with a 2-second return
B. Circumoral cyanosis
C. Capillary refill of 2 seconds
D. Erythema on the sacrum
Answer: B
Rationale: Circumoral cyanosis (blue tint around the mouth) indicates central hypoxia and
is a medical emergency.
2026 |WCU
1. When preparing to perform a physical assessment on a client, which
technique should the nurse perform first to ensure accurate data collection of
the abdomen?
A. Palpation
B. Inspection
C. Auscultation
D. Percussion
Answer: B
Rationale: For abdominal assessment, the order is Inspection, Auscultation, Percussion,
and then Palpation. This is to avoid altering bowel sounds through manipulation.
2. A nurse is caring for a patient with Clostridium difficile (C. diff). Which hand
hygiene method is mandatory after providing direct care?
A. Alcohol-based hand rub for 15 seconds
B. Washing with soap and water
C. Using a chlorhexidine gluconate (CHG) wipe
D. Rinsing with warm water only
Answer: B
Rationale: Alcohol-based rubs are ineffective against C. diff spores; physical scrubbing
with soap and water is required to mechanically remove the spores.
,3. When dawning Personal Protective Equipment (PPE) for a patient on Droplet
Precautions, what is the correct sequence?
A. Gloves, Goggles, Mask, Gown
B. Gown, Mask, Goggles, Gloves
C. Mask, Gown, Goggles, Gloves
D. Goggles, Mask, Gloves, Gown
Answer: B
Rationale: The standard donning sequence is Gown, then Mask/Respirator, then
Goggles/Face Shield, and finally Gloves.
4. The nurse is assessing a client’s blood pressure and uses a cuff that is too
narrow for the client’s arm. What is the likely result?
A. A falsely low systolic reading
B. Inability to auscultate Korotkoff sounds
C. No significant change in accuracy
D. A falsely high systolic and diastolic reading
Answer: D
Rationale: A cuff that is too small or too narrow will yield a falsely high blood pressure
reading because it requires more pressure to occlude the artery.
5. A nurse finds a pulse deficit of 12 beats per minute. How was this calculated?
A. Subtracting the carotid pulse from the radial pulse
B. Subtracting the radial pulse from the apical pulse
C. Adding the apical and radial pulses together
D. Subtracting the diastolic pressure from the systolic pressure
Answer: B
Rationale: Pulse deficit is the difference between the apical pulse (heard at the heart) and
the radial pulse (felt at the wrist) taken simultaneously.
, 6. A client is at high risk for falls. Which nursing intervention is the most
appropriate according to safety standards?
A. Keep all four side rails in the up position
B. Administer a sedative to ensure the client stays in bed
C. Place the bed in the lowest position with wheels locked
D. Apply soft wrist restraints immediately
Answer: C
Rationale: Keeping the bed low and locked is a primary safety intervention. Four side rails
are considered a restraint, which requires a specific order.
7. What is the correct order for doffing (removing) PPE?
A. Mask, Gown, Goggles, Gloves
B. Gloves, Goggles, Gown, Mask
C. Gown, Gloves, Mask, Goggles
D. Gloves, Gown, Goggles, Mask
Answer: B
Rationale: The standard doffing sequence is Gloves, then Goggles/Face Shield, then Gown,
and finally the Mask (if not using an alternative protocol where gown/gloves are removed
together).
8. The nurse is performing a skin assessment. Which finding indicates the need
for immediate intervention regarding oxygenation?
A. Skin turgor with a 2-second return
B. Circumoral cyanosis
C. Capillary refill of 2 seconds
D. Erythema on the sacrum
Answer: B
Rationale: Circumoral cyanosis (blue tint around the mouth) indicates central hypoxia and
is a medical emergency.
