NUR 101 – Fundamentals of Nursing |
Comprehensive Exam Practice Questions
with Answers & Rationales
Question 1
A nurse is caring for a client who reports pain. The nurse performs a
comprehensive assessment of the client's pain. Which component of the nursing
process is the nurse demonstrating?
A) Implementation
B) Evaluation
C) Assessment
D) Planning
Answer: C
Rationale: Assessment is the first step of the nursing process and involves
collecting comprehensive data about the client's condition. Performing a
comprehensive pain assessment involves gathering subjective and objective data to
identify the client's health status.
Question 2
The nurse formulates the following diagnosis for a client: "Impaired physical
mobility related to incisional pain as evidenced by reluctance to move and
guarding of the surgical site." This is an example of which type of nursing
diagnosis?
A) Risk diagnosis
B) Health promotion diagnosis
C) Problem-focused nursing diagnosis
D) Syndrome diagnosis
Answer: C
Rationale: A problem-focused nursing diagnosis describes a current problem that
exists at the time of assessment. It includes a diagnostic label (impaired physical
,mobility), related factors (incisional pain), and defining characteristics (reluctance
to move, guarding).
Question 3
Which nursing action demonstrates the "evaluation" phase of the nursing process?
A) Determining the client's blood pressure is now within normal range
B) Administering prescribed pain medication
C) Setting a goal for the client to ambulate independently
D) Asking the client about their medical history
Answer: A
Rationale: Evaluation involves measuring the client's response to interventions
and determining whether goals have been met. Determining the blood pressure is
within normal range compares outcomes to expected goals.
Question 4
A client's care plan includes an intervention to turn and reposition the client every
2 hours. The nurse delegates this task to an unlicensed assistive personnel (UAP).
Which component of the nursing process does this action represent?
A) Assessment
B) Implementation
C) Planning
D) Evaluation
Answer: B
Rationale: Implementation involves carrying out the care plan, including
delegating tasks to appropriate personnel. The nurse is responsible for ensuring
that the UAP is competent to perform delegated tasks.
Question 5
A nurse uses a systematic approach to problem-solving that includes assessment,
diagnosis, planning, implementation, and evaluation. This approach is known as
the:
,A) Medical model
B) Nursing process
C) Clinical pathway
D) Evidence-based practice
Answer: B
Rationale: The nursing process is a systematic, client-centered method for
providing care. It includes five steps: assessment, diagnosis, planning,
implementation, and evaluation (ADPIE). It is the foundation of professional
nursing practice.
Question 6
During which phase of the nursing process does the nurse establish short-term and
long-term goals for the client?
A) Assessment
B) Diagnosis
C) Planning
D) Evaluation
Answer: C
Rationale: During the planning phase, the nurse collaborates with the client and
healthcare team to establish goals (expected outcomes) and select interventions to
achieve those outcomes.
Question 7
A nurse is prioritizing client care using Maslow's hierarchy of needs. Which client
need should the nurse address first?
A) Client requesting education about diabetes management
B) Client experiencing difficulty breathing
C) Client expressing feelings of loneliness
D) Client requesting to discuss advance directives
Answer: B
Rationale: Maslow's hierarchy identifies physiological needs (oxygen, fluids,
nutrition, temperature, elimination, shelter, rest) as the highest priority. Difficulty
breathing is a physiological need that threatens life and must be addressed first.
, Question 8
Which of the following is an example of subjective data?
A) Temperature of 101.2°F
B) Blood pressure reading of 140/90 mm Hg
C) Client reports feeling anxious
D) Client's heart rate is 92 beats/min
Answer: C
Rationale: Subjective data are symptoms reported by the client that cannot be
directly observed or measured. The client reporting feeling anxious is a subjective
finding. Objective data (vital signs) can be measured and observed.
Question 9
A nurse is implementing a standing order for pain medication. This action is
categorized under which type of nursing intervention?
A) Dependent
B) Independent
C) Collaborative
D) Interdependent
Answer: A
Rationale: Dependent interventions are based on healthcare provider orders and
standing orders. The nurse must have a provider order to administer medication.
Independent interventions are performed without a provider order (e.g., turning a
client). Collaborative interventions involve working with other disciplines.
Question 10
A nurse notices that a client's pain level has decreased from 8/10 to 3/10 after
administering pain medication. The nurse documents this finding. Which phase of
the nursing process is being implemented?
A) Assessment
B) Planning
Comprehensive Exam Practice Questions
with Answers & Rationales
Question 1
A nurse is caring for a client who reports pain. The nurse performs a
comprehensive assessment of the client's pain. Which component of the nursing
process is the nurse demonstrating?
A) Implementation
B) Evaluation
C) Assessment
D) Planning
Answer: C
Rationale: Assessment is the first step of the nursing process and involves
collecting comprehensive data about the client's condition. Performing a
comprehensive pain assessment involves gathering subjective and objective data to
identify the client's health status.
Question 2
The nurse formulates the following diagnosis for a client: "Impaired physical
mobility related to incisional pain as evidenced by reluctance to move and
guarding of the surgical site." This is an example of which type of nursing
diagnosis?
A) Risk diagnosis
B) Health promotion diagnosis
C) Problem-focused nursing diagnosis
D) Syndrome diagnosis
Answer: C
Rationale: A problem-focused nursing diagnosis describes a current problem that
exists at the time of assessment. It includes a diagnostic label (impaired physical
,mobility), related factors (incisional pain), and defining characteristics (reluctance
to move, guarding).
Question 3
Which nursing action demonstrates the "evaluation" phase of the nursing process?
A) Determining the client's blood pressure is now within normal range
B) Administering prescribed pain medication
C) Setting a goal for the client to ambulate independently
D) Asking the client about their medical history
Answer: A
Rationale: Evaluation involves measuring the client's response to interventions
and determining whether goals have been met. Determining the blood pressure is
within normal range compares outcomes to expected goals.
Question 4
A client's care plan includes an intervention to turn and reposition the client every
2 hours. The nurse delegates this task to an unlicensed assistive personnel (UAP).
Which component of the nursing process does this action represent?
A) Assessment
B) Implementation
C) Planning
D) Evaluation
Answer: B
Rationale: Implementation involves carrying out the care plan, including
delegating tasks to appropriate personnel. The nurse is responsible for ensuring
that the UAP is competent to perform delegated tasks.
Question 5
A nurse uses a systematic approach to problem-solving that includes assessment,
diagnosis, planning, implementation, and evaluation. This approach is known as
the:
,A) Medical model
B) Nursing process
C) Clinical pathway
D) Evidence-based practice
Answer: B
Rationale: The nursing process is a systematic, client-centered method for
providing care. It includes five steps: assessment, diagnosis, planning,
implementation, and evaluation (ADPIE). It is the foundation of professional
nursing practice.
Question 6
During which phase of the nursing process does the nurse establish short-term and
long-term goals for the client?
A) Assessment
B) Diagnosis
C) Planning
D) Evaluation
Answer: C
Rationale: During the planning phase, the nurse collaborates with the client and
healthcare team to establish goals (expected outcomes) and select interventions to
achieve those outcomes.
Question 7
A nurse is prioritizing client care using Maslow's hierarchy of needs. Which client
need should the nurse address first?
A) Client requesting education about diabetes management
B) Client experiencing difficulty breathing
C) Client expressing feelings of loneliness
D) Client requesting to discuss advance directives
Answer: B
Rationale: Maslow's hierarchy identifies physiological needs (oxygen, fluids,
nutrition, temperature, elimination, shelter, rest) as the highest priority. Difficulty
breathing is a physiological need that threatens life and must be addressed first.
, Question 8
Which of the following is an example of subjective data?
A) Temperature of 101.2°F
B) Blood pressure reading of 140/90 mm Hg
C) Client reports feeling anxious
D) Client's heart rate is 92 beats/min
Answer: C
Rationale: Subjective data are symptoms reported by the client that cannot be
directly observed or measured. The client reporting feeling anxious is a subjective
finding. Objective data (vital signs) can be measured and observed.
Question 9
A nurse is implementing a standing order for pain medication. This action is
categorized under which type of nursing intervention?
A) Dependent
B) Independent
C) Collaborative
D) Interdependent
Answer: A
Rationale: Dependent interventions are based on healthcare provider orders and
standing orders. The nurse must have a provider order to administer medication.
Independent interventions are performed without a provider order (e.g., turning a
client). Collaborative interventions involve working with other disciplines.
Question 10
A nurse notices that a client's pain level has decreased from 8/10 to 3/10 after
administering pain medication. The nurse documents this finding. Which phase of
the nursing process is being implemented?
A) Assessment
B) Planning
