**Title:** **Foundations of Safe Practice:
NCLEX-RN Fundamentals & Patient Care
Exam**
---
### Question 1 of 104
A nurse is preparing to insert an indwelling urinary catheter for a female client. Which action maintains
sterile technique?
A) Open catheter kit after donning sterile gloves.
B) Clean labia with back-and-forth motion.
C) Separate labia with non-dominant hand and keep in place.
D) Insert catheter until urine flows, then advance 5-7 inches.
💫RATIONALE✔️✔️: Non-dominant hand separates labia and remains in place (C). Clean front-to-back.
Advance 2-3 inches after urine flow.
💫ANSWER✔️✔️: C) Separate labia with non-dominant hand and keep in place.
---
### Question 2 of 104
A client with NG tube to suction asks why it's needed. Best response?
,A) "Provides nutrition."
B) "Prevents nausea."
C) "Removes stomach contents to prevent aspiration."
D) "Decompresses stomach by removing gas and fluid."
💫RATIONALE✔️✔️: NG tube to suction decompresses stomach by removing gas and fluid (D).
💫ANSWER✔️✔️: D) "Decompresses stomach by removing gas and fluid."
---
### Question 3 of 104
**Select-All-That-Apply (SATA):** A nurse teaches colostomy care. Which instructions correct? (Select
all that apply.)
A) Change pouch when 1/3 full.
B) Clean peristomal skin with mild soap/water.
C) Cut wafer opening slightly larger than stoma.
D) Report dark purple stoma.
E) Apply lotion around stoma.
💫RATIONALE✔️✔️: Clean with mild soap/water (B), cut wafer slightly larger (C), report color changes (D)
correct. Pouch emptied when 1/3-1/2 full. Avoid lotions (prevent adhesion).
💫ANSWER✔️✔️: B, C, D
---
### Question 4 of 104
,A nurse administers hepatitis B vaccine IM to an adult. Which site is most appropriate?
A) Ventrogluteal
B) Dorsogluteal
C) Deltoid
D) Vastus lateralis
💫RATIONALE✔️✔️: Deltoid (C) is preferred site for IM vaccines in adults.
💫ANSWER✔️✔️: C) Deltoid
---
### Question 5 of 104
A nurse prepares to administer enteral feeding via NG tube. Which action best verifies placement?
A) Auscultate air insufflation.
B) Measure pH of aspirated gastric contents.
C) Check external tube length.
D) Flush with water and observe for coughing.
💫RATIONALE✔️✔️: pH testing of aspirated contents (B) most reliable (gastric pH 1-4).
💫ANSWER✔️✔️: B) Measure pH of aspirated gastric contents.
---
### Question 6 of 104
, A client on clear liquid diet. Which item should the nurse offer?
A) Vanilla ice cream
B) Cream of chicken soup
C) Apple juice
D) Orange sherbet
💫RATIONALE✔️✔️: Apple juice (C) is a clear liquid. Ice cream, cream soups, sherbet are not clear.
💫ANSWER✔️✔️: C) Apple juice
---
### Question 7 of 104
**Select-All-That-Apply (SATA):** A nurse teaches deep breathing/coughing after surgery. Which
instructions correct? (Select all that apply.)
A) Splint incision with pillow.
B) Take 3 deep breaths before each cough.
C) Cough deeply from throat.
D) Repeat exercises every hour.
E) Hold breath for 10 seconds after deep breath.
💫RATIONALE✔️✔️: Splinting (A), several deep breaths before coughing (B), hourly exercises (D) correct.
Cough from chest, not throat. Hold breath 2-3 seconds.
💫ANSWER✔️✔️: A, B, D
---
NCLEX-RN Fundamentals & Patient Care
Exam**
---
### Question 1 of 104
A nurse is preparing to insert an indwelling urinary catheter for a female client. Which action maintains
sterile technique?
A) Open catheter kit after donning sterile gloves.
B) Clean labia with back-and-forth motion.
C) Separate labia with non-dominant hand and keep in place.
D) Insert catheter until urine flows, then advance 5-7 inches.
💫RATIONALE✔️✔️: Non-dominant hand separates labia and remains in place (C). Clean front-to-back.
Advance 2-3 inches after urine flow.
💫ANSWER✔️✔️: C) Separate labia with non-dominant hand and keep in place.
---
### Question 2 of 104
A client with NG tube to suction asks why it's needed. Best response?
,A) "Provides nutrition."
B) "Prevents nausea."
C) "Removes stomach contents to prevent aspiration."
D) "Decompresses stomach by removing gas and fluid."
💫RATIONALE✔️✔️: NG tube to suction decompresses stomach by removing gas and fluid (D).
💫ANSWER✔️✔️: D) "Decompresses stomach by removing gas and fluid."
---
### Question 3 of 104
**Select-All-That-Apply (SATA):** A nurse teaches colostomy care. Which instructions correct? (Select
all that apply.)
A) Change pouch when 1/3 full.
B) Clean peristomal skin with mild soap/water.
C) Cut wafer opening slightly larger than stoma.
D) Report dark purple stoma.
E) Apply lotion around stoma.
💫RATIONALE✔️✔️: Clean with mild soap/water (B), cut wafer slightly larger (C), report color changes (D)
correct. Pouch emptied when 1/3-1/2 full. Avoid lotions (prevent adhesion).
💫ANSWER✔️✔️: B, C, D
---
### Question 4 of 104
,A nurse administers hepatitis B vaccine IM to an adult. Which site is most appropriate?
A) Ventrogluteal
B) Dorsogluteal
C) Deltoid
D) Vastus lateralis
💫RATIONALE✔️✔️: Deltoid (C) is preferred site for IM vaccines in adults.
💫ANSWER✔️✔️: C) Deltoid
---
### Question 5 of 104
A nurse prepares to administer enteral feeding via NG tube. Which action best verifies placement?
A) Auscultate air insufflation.
B) Measure pH of aspirated gastric contents.
C) Check external tube length.
D) Flush with water and observe for coughing.
💫RATIONALE✔️✔️: pH testing of aspirated contents (B) most reliable (gastric pH 1-4).
💫ANSWER✔️✔️: B) Measure pH of aspirated gastric contents.
---
### Question 6 of 104
, A client on clear liquid diet. Which item should the nurse offer?
A) Vanilla ice cream
B) Cream of chicken soup
C) Apple juice
D) Orange sherbet
💫RATIONALE✔️✔️: Apple juice (C) is a clear liquid. Ice cream, cream soups, sherbet are not clear.
💫ANSWER✔️✔️: C) Apple juice
---
### Question 7 of 104
**Select-All-That-Apply (SATA):** A nurse teaches deep breathing/coughing after surgery. Which
instructions correct? (Select all that apply.)
A) Splint incision with pillow.
B) Take 3 deep breaths before each cough.
C) Cough deeply from throat.
D) Repeat exercises every hour.
E) Hold breath for 10 seconds after deep breath.
💫RATIONALE✔️✔️: Splinting (A), several deep breaths before coughing (B), hourly exercises (D) correct.
Cough from chest, not throat. Hold breath 2-3 seconds.
💫ANSWER✔️✔️: A, B, D
---
