1. A nurse is educating a patient about the importance of hand
hygiene. Which of the following methods is most effective in
preventing infection?
A. Wearing gloves at all times
B. Using hand sanitizer every hour
C. Proper handwashing with soap and water
D. Rinsing hands under running water
Answer: C
Rationale: Handwashing with soap and water is the most effective
method for removing microorganisms, preventing the spread of
infection.
2. When performing a physical assessment, the nurse uses the
dorsal surface of the hand. This technique is best for assessing
which of the following?
A. Skin texture
B. Temperature
C. Pulse
D. Vibration
Answer: B
Rationale: The dorsal surface of the hand is more sensitive to
temperature changes.
3. Which of the following is the most reliable indicator of pain?
A. Vital signs
B. Facial expressions
C. Self-report by the patient
D. Body movements
Answer: C
Rationale: The patient's self-report is the gold standard for
assessing pain.
,4. A nurse is preparing to administer a medication. Which of the
following actions demonstrates adherence to the five rights of
medication administration?
A. Checking the patient’s wristband for identification
B. Documenting the medication after administering it
C. Verifying the medication against the prescription
D. All of the above
Answer: D
Rationale: Ensuring the correct patient, medication, dose, route, and
time are essential to safe medication administration.
5. The nurse is caring for a client with a nasogastric tube.
Which of the following is the best method to confirm
placement?
A. Injecting air and listening over the stomach
B. Observing for gastric content aspirate
C. Testing pH of aspirate
D. Asking the patient if they feel discomfort
Answer: C
Rationale: Testing the pH of aspirate is the most reliable bedside
method for confirming nasogastric tube placement.
6. A patient is at risk for pressure ulcers. Which intervention is
most appropriate?
A. Massage over bony prominences
B. Reposition the patient every 2 hours
C. Apply alcohol-based lotion to the skin
D. Use a donut-shaped cushion
, Answer: B
Rationale: Regular repositioning helps to prevent pressure ulcers by
relieving pressure points.
7. The nurse is using the SBAR communication tool. What does
"B" stand for?
A. Background
B. Behavior
C. Baseline
D. Best practice
Answer: A
Rationale: "B" in SBAR stands for Background, which provides
context for the situation.
8. Which nursing action demonstrates maintaining patient
confidentiality?
A. Discussing the patient's condition in a private room
B. Sharing the patient's information with family members
C. Posting about the patient’s care on social media
D. Reviewing the patient’s chart for personal curiosity
Answer: A
Rationale: Confidentiality is maintained by discussing sensitive
information privately and only with authorized individuals.
9. When a nurse delegates a task to an unlicensed assistive
personnel (UAP), which responsibility remains with the nurse?
A. Performing the task
B. Supervising the UAP
C. Documenting the task
D. Assigning the task
hygiene. Which of the following methods is most effective in
preventing infection?
A. Wearing gloves at all times
B. Using hand sanitizer every hour
C. Proper handwashing with soap and water
D. Rinsing hands under running water
Answer: C
Rationale: Handwashing with soap and water is the most effective
method for removing microorganisms, preventing the spread of
infection.
2. When performing a physical assessment, the nurse uses the
dorsal surface of the hand. This technique is best for assessing
which of the following?
A. Skin texture
B. Temperature
C. Pulse
D. Vibration
Answer: B
Rationale: The dorsal surface of the hand is more sensitive to
temperature changes.
3. Which of the following is the most reliable indicator of pain?
A. Vital signs
B. Facial expressions
C. Self-report by the patient
D. Body movements
Answer: C
Rationale: The patient's self-report is the gold standard for
assessing pain.
,4. A nurse is preparing to administer a medication. Which of the
following actions demonstrates adherence to the five rights of
medication administration?
A. Checking the patient’s wristband for identification
B. Documenting the medication after administering it
C. Verifying the medication against the prescription
D. All of the above
Answer: D
Rationale: Ensuring the correct patient, medication, dose, route, and
time are essential to safe medication administration.
5. The nurse is caring for a client with a nasogastric tube.
Which of the following is the best method to confirm
placement?
A. Injecting air and listening over the stomach
B. Observing for gastric content aspirate
C. Testing pH of aspirate
D. Asking the patient if they feel discomfort
Answer: C
Rationale: Testing the pH of aspirate is the most reliable bedside
method for confirming nasogastric tube placement.
6. A patient is at risk for pressure ulcers. Which intervention is
most appropriate?
A. Massage over bony prominences
B. Reposition the patient every 2 hours
C. Apply alcohol-based lotion to the skin
D. Use a donut-shaped cushion
, Answer: B
Rationale: Regular repositioning helps to prevent pressure ulcers by
relieving pressure points.
7. The nurse is using the SBAR communication tool. What does
"B" stand for?
A. Background
B. Behavior
C. Baseline
D. Best practice
Answer: A
Rationale: "B" in SBAR stands for Background, which provides
context for the situation.
8. Which nursing action demonstrates maintaining patient
confidentiality?
A. Discussing the patient's condition in a private room
B. Sharing the patient's information with family members
C. Posting about the patient’s care on social media
D. Reviewing the patient’s chart for personal curiosity
Answer: A
Rationale: Confidentiality is maintained by discussing sensitive
information privately and only with authorized individuals.
9. When a nurse delegates a task to an unlicensed assistive
personnel (UAP), which responsibility remains with the nurse?
A. Performing the task
B. Supervising the UAP
C. Documenting the task
D. Assigning the task
