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,R 224 Fundamentals Skills Exam 1 | Chamberlain
1. A nurse is assessing a client who reports feeling nauseated and dizzy. The nurse observes that the
client is pale and diaphoretic. Which type of data does the nurse's observation of pallor and
diaphoresis represent?
A) Subjective data
B) Objective data
C) Secondary data
D) Inferential data
Correct Answer: Objective data
Rationale: Objective data are observations and measurements that the nurse obtains through the
senses (sight, touch, hearing, smell). Pallor and diaphoresis are directly observable by the nurse and
can be verified. Subjective data include the client's reported feelings (nausea, dizziness) that cannot
be independently verified by the nurse.
2. A nurse is caring for a client on contact precautions for MRSA. Which PPE should the nurse don
before entering the client's room?
A) Gloves only
B) Mask and gloves
C) Gown and gloves
D) Gown, mask, and gloves
Correct Answer: Gown and gloves
Rationale: Contact precautions require a gown and gloves when entering the client's room. A mask is
not required unless there is a risk of splash or spray. Contact precautions prevent transmission of
organisms spread by direct or indirect contact, such as MRSA, VRE, and C. difficile.
3. A nurse is teaching a client how to use a walker. Which instruction should the nurse include?
A) "Move the walker forward 6 to 8 inches, then step forward."
,B) "Lift the walker off the floor with each step."
C) "Place the walker as far ahead as you can reach."
D) "Use the walker only when you feel unsteady."
Correct Answer: "Move the walker forward 6 to 8 inches, then step forward."
Rationale: When using a walker, the client should move the walker forward 6 to 8 inches, then step
forward into it while maintaining balance. The walker should remain on the floor (not lifted) for
stability. Placing the walker too far ahead can cause loss of balance. The walker should be used
consistently for safety.
4. A nurse is documenting a client's assessment using the SOAP format. Which component represents
the nurse's interpretation of the data?
A) Subjective
B) Objective
C) Assessment
D) Plan
Correct Answer: Assessment
Rationale: In the SOAP format, Assessment (A) represents the nurse's interpretation, hypothesis, or
evaluation based on the collected data cues. Subjective (S) includes patient-reported information,
Objective (O) includes measurable data, and Plan (P) includes intended interventions.
5. A nurse is preparing to administer medications to a client. Which action demonstrates the principle
of "right patient" prior to medication administration?
A) Asking the client to state their full name and date of birth
B) Checking the client's room number
C) Verifying the client's diagnosis
D) Asking the client if they are ready for medication
, Correct Answer: Asking the client to state their full name and date of birth
Rationale: The "right patient" is verified using two patient identifiers, typically the client's full name
and date of birth. Room numbers and diagnoses are not reliable identifiers and can change. Asking if
the client is ready does not verify identity.
6. A nurse is assessing a client who states, "My pain is a 6 out of 10." Which type of data does this
represent?
A) Objective data
B) Subjective data
C) Observable data
D) Measurable data
Correct Answer: Subjective data
Rationale: Subjective data are information provided by the client that cannot be independently
verified by the nurse. The client's report of pain level is subjective because it is based on their
personal perception. Objective data include measurable findings such as vital signs or observable
behaviors.
7. A nurse is preparing to don PPE before entering a client's room. Which sequence is correct?
A) Gown, mask, gloves, eyewear
B) Gown, mask, eyewear, gloves
C) Gloves, gown, mask, eyewear
D) Mask, eyewear, gown, gloves
Correct Answer: Gown, mask, eyewear, gloves
Rationale: The correct sequence for donning PPE is: gown first, then mask (or respirator), then
eyewear (goggles or face shield), and finally gloves. Gloves are applied last because they are the most
contaminated item and should cover the cuffs of the gown. This sequence ensures maximum
protection and prevents contamination.
,R 224 Fundamentals Skills Exam 1 | Chamberlain
1. A nurse is assessing a client who reports feeling nauseated and dizzy. The nurse observes that the
client is pale and diaphoretic. Which type of data does the nurse's observation of pallor and
diaphoresis represent?
A) Subjective data
B) Objective data
C) Secondary data
D) Inferential data
Correct Answer: Objective data
Rationale: Objective data are observations and measurements that the nurse obtains through the
senses (sight, touch, hearing, smell). Pallor and diaphoresis are directly observable by the nurse and
can be verified. Subjective data include the client's reported feelings (nausea, dizziness) that cannot
be independently verified by the nurse.
2. A nurse is caring for a client on contact precautions for MRSA. Which PPE should the nurse don
before entering the client's room?
A) Gloves only
B) Mask and gloves
C) Gown and gloves
D) Gown, mask, and gloves
Correct Answer: Gown and gloves
Rationale: Contact precautions require a gown and gloves when entering the client's room. A mask is
not required unless there is a risk of splash or spray. Contact precautions prevent transmission of
organisms spread by direct or indirect contact, such as MRSA, VRE, and C. difficile.
3. A nurse is teaching a client how to use a walker. Which instruction should the nurse include?
A) "Move the walker forward 6 to 8 inches, then step forward."
,B) "Lift the walker off the floor with each step."
C) "Place the walker as far ahead as you can reach."
D) "Use the walker only when you feel unsteady."
Correct Answer: "Move the walker forward 6 to 8 inches, then step forward."
Rationale: When using a walker, the client should move the walker forward 6 to 8 inches, then step
forward into it while maintaining balance. The walker should remain on the floor (not lifted) for
stability. Placing the walker too far ahead can cause loss of balance. The walker should be used
consistently for safety.
4. A nurse is documenting a client's assessment using the SOAP format. Which component represents
the nurse's interpretation of the data?
A) Subjective
B) Objective
C) Assessment
D) Plan
Correct Answer: Assessment
Rationale: In the SOAP format, Assessment (A) represents the nurse's interpretation, hypothesis, or
evaluation based on the collected data cues. Subjective (S) includes patient-reported information,
Objective (O) includes measurable data, and Plan (P) includes intended interventions.
5. A nurse is preparing to administer medications to a client. Which action demonstrates the principle
of "right patient" prior to medication administration?
A) Asking the client to state their full name and date of birth
B) Checking the client's room number
C) Verifying the client's diagnosis
D) Asking the client if they are ready for medication
, Correct Answer: Asking the client to state their full name and date of birth
Rationale: The "right patient" is verified using two patient identifiers, typically the client's full name
and date of birth. Room numbers and diagnoses are not reliable identifiers and can change. Asking if
the client is ready does not verify identity.
6. A nurse is assessing a client who states, "My pain is a 6 out of 10." Which type of data does this
represent?
A) Objective data
B) Subjective data
C) Observable data
D) Measurable data
Correct Answer: Subjective data
Rationale: Subjective data are information provided by the client that cannot be independently
verified by the nurse. The client's report of pain level is subjective because it is based on their
personal perception. Objective data include measurable findings such as vital signs or observable
behaviors.
7. A nurse is preparing to don PPE before entering a client's room. Which sequence is correct?
A) Gown, mask, gloves, eyewear
B) Gown, mask, eyewear, gloves
C) Gloves, gown, mask, eyewear
D) Mask, eyewear, gown, gloves
Correct Answer: Gown, mask, eyewear, gloves
Rationale: The correct sequence for donning PPE is: gown first, then mask (or respirator), then
eyewear (goggles or face shield), and finally gloves. Gloves are applied last because they are the most
contaminated item and should cover the cuffs of the gown. This sequence ensures maximum
protection and prevents contamination.
