PRE-TEST |200 MULTIPLE-CHOICE
QUESTIONS WITH ANSWERS AND
RATIONALES
Section 1: Fundamentals of Nursing (Questions 1-25)
1. A nurse enters a client's room and finds the client lying on the floor.
What should the nurse do first?
A) Complete an incident report
B) Assess the client for injury
C) Notify the healthcare provider
D) Help the client back into bed
Correct Answer: B
Rationale: The client's immediate safety and condition must be assessed
before moving the client or completing documentation. Assessment is the
priority action to determine the extent of injury and prevent further harm.
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,2. Which action is most effective for preventing healthcare-associated
infections (HAIs)?
A) Wearing a mask during all client interactions
B) Performing appropriate hand hygiene
C) Using sterile gloves for every procedure
D) Administering prophylactic antibiotics
Correct Answer: B
Rationale: Proper hand hygiene is the single most effective method of
preventing transmission of infection. Other measures are important but
secondary to hand hygiene.
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3. A nurse is providing care to a client who is a member of a culture that is
"present-oriented." The client is noncompliant with future appointments.
What should the nurse do?
A) Emphasize the importance of future appointments
B) Work with the client to schedule appointments that fit their timeline
C) Discharge the client from the practice
,D) Tell the client that they must comply
Correct Answer: B
Rationale: Culturally competent care requires adapting to the client's
orientation. For a present-oriented client, the nurse should focus on
immediate needs and help them schedule appointments that are
convenient.
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4. A nurse is formulating a nursing diagnosis for a patient with shortness of
breath. Which is an appropriately written diagnostic statement?
A) Dyspnea related to fluid volume overload
B) Impaired Gas Exchange related to fluid in the lungs
C) Ineffective Breathing Pattern related to anxiety
D) Risk for Impaired Gas Exchange related to pneumonia
Correct Answer: C
Rationale: A properly written nursing diagnosis follows the PES format
(Problem, Etiology, Signs/Symptoms). "Ineffective Breathing Pattern related
to anxiety" is correctly formatted with a NANDA-approved problem
statement and related factor.
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5. A patient has a nursing diagnosis of "Impaired Physical Mobility" related
to a fractured femur. An appropriate goal is:
A) The patient will be turned every 2 hours
B) The patient will ambulate with assistance by discharge
C) The nurse will assist the patient with range of motion exercises
D) The patient will not develop a pressure injury
Correct Answer: B
Rationale: A goal must be patient-centered and measurable. "The patient
will ambulate with assistance by discharge" is specific and patient-
centered. Options A and C are interventions; D is not directly related to
mobility.
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6. A nurse is caring for a patient who is in pain. The nurse administers
prescribed pain medication and monitors the patient's response. Which
step of the nursing process is the nurse completing?
A) Assessment