TEST QUESTIONS AND ANSWERS
2026 3 VERSIONS
Fall Update | 100% Correct | Latest Version
Question 1
A nurse is preparing to administer medication to a client. Which of the
following actions is part of safe medication administration practice?
A. Verify the client using two identifiers.
B. Ask the roommate to confirm the client's identity.
C. Give the medication without checking identification.
D. Use the client's room number to verify identity.
*Correct Answer: A. Verify the client using two identifiers. *
Rationale: The use of two client identifiers (such as name and date of birth) is
a standard safety practice to prevent medication errors. Room numbers and
roommate confirmation are not acceptable methods of identification.
Question 2
A nurse notes that a client's respiratory rate is 8 breaths per minute. Which
of the following actions should the nurse take?
A. Notify the provider immediately.
B. Document the finding only.
,C. Encourage the client to drink fluids.
D. Reassess the client in 4 hours.
*Correct Answer: A. Notify the provider immediately. *
Rationale: A respiratory rate of 8/min is significantly below the normal range
and indicates respiratory depression, which is life-threatening. Immediate
notification of the provider is required.
Question 3
Which of the following clients requires the nurse's immediate attention?
A. A client with an airway obstruction.
B. A client with a mild headache.
C. A client requesting water.
D. A client with a stable fracture.
*Correct Answer: A. A client with an airway obstruction. *
Rationale: According to the ABC (Airway, Breathing, Circulation) priority
framework, an airway obstruction is the most life-threatening condition and
requires immediate intervention.
Question 4
A nurse is teaching a client about hand hygiene. When is alcohol-based
hand sanitizer appropriate to use?
A. When hands are not visibly soiled.
B. After exposure to Clostridium difficile.
C. When hands are visibly dirty.
D. After fecal contamination.
,*Correct Answer: A. When hands are not visibly soiled. *
Rationale: Alcohol-based hand sanitizers are appropriate when hands are not
visibly soiled. For C. difficile, soap and water are required because alcohol-
based sanitizers do not kill spores.
Question 5
Which of the following findings indicates a wound infection?
A. Purulent drainage.
B. Clear wound drainage.
C. Pink granulation tissue.
D. Closed incision.
*Correct Answer: A. Purulent drainage. *
Rationale: Purulent drainage (yellow, green, or thick discharge) is a classic
sign of wound infection. Pink granulation tissue indicates healing, and clear
drainage is normal serous fluid.
Question 6
A nurse is assessing a client's skin and notes edema. Which of the following
techniques should the nurse use to assess edema?
A. Pinch the skin on the sternum.
B. Compress the skin over a bony prominence for 5 seconds.
C. Observe skin color changes.
D. Palpate the skin for temperature.
*Correct Answer: B. Compress the skin over a bony prominence for 5
seconds. *
, Rationale: Edema is assessed by pressing the skin over a bony prominence
(such as the tibia or sacrum) for 5 seconds and measuring the depth of the
indentation. Pitting edema is graded from 1+ (2mm) to 4+ (8mm).
Question 7
Which of the following clients is at greatest risk for developing a pressure
injury?
A. A client who ambulates independently.
B. A client with limited mobility.
C. A client with intact sensation.
D. A client who changes position frequently.
*Correct Answer: B. A client with limited mobility. *
Rationale: Limited mobility increases the duration of pressure on tissues and
impairs circulation, significantly increasing the risk of pressure injury
development. Clients who are mobile and can change position independently
are at lower risk.
Question 8
Which of the following is the purpose of incentive spirometry?
A. Prevent atelectasis.
B. Increase pain.
C. Reduce lung volume.
D. Cause fatigue.
*Correct Answer: A. Prevent atelectasis. *