NUR 256 - Exam 1 UPDATED ACTUAL
Exam Questions and CORRECT Answers
A nurse is performing a pre-admission assessment on a client and employs the use of nonverbal
and verbal communication which of the following actions demonstrates the use of a nonverbal
communication technique by the nurse
A. asking the client to clarify a statement
B. asking the client open-ended questions
C. maintain a fair distance between self and client
D. stating the name and providing credentials upon entering the client's room - CORRECT
ANSWER maintain a fair distance between self and client
A nurse is preparing to irrigate a client's leg wound what PPE should the nurse wear?
surgical cap
gown
goggles
gloves
N95 mask - CORRECT ANSWER Goggles, gown, gloves
A nurse has performed pre-operative care on a client and is transferring the client to the surgical
holding area when the client states " I have changed my mind; Ido not want to have this surgery"
which of the following ethical principles is the client using?
A. Nonmaleficence
B. Autonomy
C. Justice
D. Fidelity - CORRECT ANSWER Autonomy
,A nurse is preparing to perform a physical examination on a client. Which of the following
interventions should the nurse perform to ensure client privacy?
A. Close the examination room door but do not pull the curtain in the examination room
B. Remain in the client's room while the client is getting undressed
C. Ask the client if they would like to empty their bladder or bowels before the physical
examination begins
D. Do not expose any more of the client's body than required at a time - CORRECT
ANSWER Do not expose any more of the client's body than required at a time
A nurse is assisting a client with ambulating around the nurses' station. which of the following
steps of the nursing process is the nurse performing?
A. Implementation
B. Evaluation
C. Analysis
D. Planning - CORRECT ANSWER Implementation
A nurse is performing an assessment on a client the client states "I have a dry cough every
morning when I wake up" which of the following is the type of date the nurse is collecting?
A. Subjective
B. Social determinants of health
C. Objective
D. Olfactory - CORRECT ANSWER Objective
A nurse is caring for a client who is crying and appears upset after receiving news that they will
need to have a surgical procedure which of the following actions should the nurse take to display
empathy towards the client?
,A. Tell the client that everything will be fine
B. Change the subject while the client is discussing their feelings
C. Show interest in the client's feelings by acknowledging that they are upset
D. Tell the client that it is wrong to be crying over this situation - CORRECT
ANSWER Show interest in the client's feelings by acknowledging that they are upset
A nurse is preparing to assess a newly admitted client which of the following pieces of
equipment does the nurse need to begin the inspection part of the physical examination?
Electrocardiogram monitor
Tongue Depressor
Doppler
Penlight
Tape measure - CORRECT ANSWER Tongue depressor, penlight, tape measure
A nurse is performing auscultation during a client's physical assessment which of the following
tools should the nurse use for this part of the assessment?
A. Tongue Depressor
B. Penlight
C. Reflex hammer
D. Stethoscope - CORRECT ANSWER Stethoscope
A nurse in the emergency department has received report on a child who has a laceration to the
right calf which of the following steps of the nursing process should the nurse perform first?
A. Assessment
B. Analysis
C. Evaluation
, D. Planning - CORRECT ANSWER Assessment
A nurse is preparing to perform palpation on a client during a physical assessment. Which of the
following findings is the nurse assessing during palpation?
A. Unexpected sounds made by tapping on the client's skin
B. Skin temperature, moisture, or unexpected findings
C. Heart sounds, lunch sounds, and bowel sounds
D. The client's cleanliness and grooming - CORRECT ANSWER Skin temperature,
moisture, or unexpected findings
A nurse is performing a physical assessment of a client who has reported abdominal tenderness
which of the following actions should the nurse take?
A. Use the soft end of a cotton swab over the client's abdomen
B. Auscultate the tender areas of the client's abdomen through clothing
C. Palpate the tender areas of the client's abdomen last
D. Use deep palpation when assessing the client's abdomen - CORRECT
ANSWER Palpate the tender areas of the client's abdomen last
A nurse has just received report on a newly admitted client who reports abdominal tenderness in
the lower right quadrant which of the following is the first step the nurse should perform during
the abdominal assessment?
A. Palpation
B. Percussion
C. Auscultation
D. Inspection - CORRECT ANSWER Inspection
Exam Questions and CORRECT Answers
A nurse is performing a pre-admission assessment on a client and employs the use of nonverbal
and verbal communication which of the following actions demonstrates the use of a nonverbal
communication technique by the nurse
A. asking the client to clarify a statement
B. asking the client open-ended questions
C. maintain a fair distance between self and client
D. stating the name and providing credentials upon entering the client's room - CORRECT
ANSWER maintain a fair distance between self and client
A nurse is preparing to irrigate a client's leg wound what PPE should the nurse wear?
surgical cap
gown
goggles
gloves
N95 mask - CORRECT ANSWER Goggles, gown, gloves
A nurse has performed pre-operative care on a client and is transferring the client to the surgical
holding area when the client states " I have changed my mind; Ido not want to have this surgery"
which of the following ethical principles is the client using?
A. Nonmaleficence
B. Autonomy
C. Justice
D. Fidelity - CORRECT ANSWER Autonomy
,A nurse is preparing to perform a physical examination on a client. Which of the following
interventions should the nurse perform to ensure client privacy?
A. Close the examination room door but do not pull the curtain in the examination room
B. Remain in the client's room while the client is getting undressed
C. Ask the client if they would like to empty their bladder or bowels before the physical
examination begins
D. Do not expose any more of the client's body than required at a time - CORRECT
ANSWER Do not expose any more of the client's body than required at a time
A nurse is assisting a client with ambulating around the nurses' station. which of the following
steps of the nursing process is the nurse performing?
A. Implementation
B. Evaluation
C. Analysis
D. Planning - CORRECT ANSWER Implementation
A nurse is performing an assessment on a client the client states "I have a dry cough every
morning when I wake up" which of the following is the type of date the nurse is collecting?
A. Subjective
B. Social determinants of health
C. Objective
D. Olfactory - CORRECT ANSWER Objective
A nurse is caring for a client who is crying and appears upset after receiving news that they will
need to have a surgical procedure which of the following actions should the nurse take to display
empathy towards the client?
,A. Tell the client that everything will be fine
B. Change the subject while the client is discussing their feelings
C. Show interest in the client's feelings by acknowledging that they are upset
D. Tell the client that it is wrong to be crying over this situation - CORRECT
ANSWER Show interest in the client's feelings by acknowledging that they are upset
A nurse is preparing to assess a newly admitted client which of the following pieces of
equipment does the nurse need to begin the inspection part of the physical examination?
Electrocardiogram monitor
Tongue Depressor
Doppler
Penlight
Tape measure - CORRECT ANSWER Tongue depressor, penlight, tape measure
A nurse is performing auscultation during a client's physical assessment which of the following
tools should the nurse use for this part of the assessment?
A. Tongue Depressor
B. Penlight
C. Reflex hammer
D. Stethoscope - CORRECT ANSWER Stethoscope
A nurse in the emergency department has received report on a child who has a laceration to the
right calf which of the following steps of the nursing process should the nurse perform first?
A. Assessment
B. Analysis
C. Evaluation
, D. Planning - CORRECT ANSWER Assessment
A nurse is preparing to perform palpation on a client during a physical assessment. Which of the
following findings is the nurse assessing during palpation?
A. Unexpected sounds made by tapping on the client's skin
B. Skin temperature, moisture, or unexpected findings
C. Heart sounds, lunch sounds, and bowel sounds
D. The client's cleanliness and grooming - CORRECT ANSWER Skin temperature,
moisture, or unexpected findings
A nurse is performing a physical assessment of a client who has reported abdominal tenderness
which of the following actions should the nurse take?
A. Use the soft end of a cotton swab over the client's abdomen
B. Auscultate the tender areas of the client's abdomen through clothing
C. Palpate the tender areas of the client's abdomen last
D. Use deep palpation when assessing the client's abdomen - CORRECT
ANSWER Palpate the tender areas of the client's abdomen last
A nurse has just received report on a newly admitted client who reports abdominal tenderness in
the lower right quadrant which of the following is the first step the nurse should perform during
the abdominal assessment?
A. Palpation
B. Percussion
C. Auscultation
D. Inspection - CORRECT ANSWER Inspection
