2025/2026 Update | 100% Correct Latest
QUESTION 1
A nurse is reinforcing teaching with a client about proper hand hygiene. Which of the following
actions by the client indicates understanding?
A. Washing hands for at least 10 seconds.
B. Using cold water to rinse hands.
C. Turning off the faucet with a clean paper towel after washing.
D. Drying hands on a shared cloth towel.
CORRECT ANSWER: C
RATIONALE: Turning off the faucet with a clean paper towel prevents recontamination of clean
hands. The other options fail to meet recommended infection-control practices.
QUESTION 2
A nurse should identify that which of the following actions violates HIPAA regulations?
A. Discussing a client’s treatment plan with another nurse involved in the client’s care.
B. Leaving a client’s medical record open on a desk unattended.
C. Providing information about a client’s condition to a provider.
D. Transferring a client’s record to a specialist upon written consent.
CORRECT ANSWER: B
RATIONALE: Leaving records accessible exposes private health information to unauthorized
individuals, violating confidentiality laws.
QUESTION 3
Before providing morning care, a nurse notices the client’s identification band is missing. What
should the nurse do first?
A. Obtain a new band and attach it to the client’s wrist.
B. Ask the client to state their name and birth date.
C. Call the provider for identification verification.
D. Ask a family member to confirm the client’s identity.
,CORRECT ANSWER: A
RATIONALE: A missing identification band must be replaced immediately before any procedures
to maintain accurate client identification.
QUESTION 4
Which position should the nurse place a client in for insertion of a nasogastric tube?
A. Supine
B. High-Fowler’s
C. Prone
D. Trendelenburg
CORRECT ANSWER: B
RATIONALE: High-Fowler’s position facilitates insertion of the NG tube and reduces risk of
aspiration.
QUESTION 5
Which of the following findings indicates fluid volume deficit?
A. Bounding pulse
B. Crackles in the lungs
C. Weight gain
D. Orthostatic hypotension
CORRECT ANSWER: D
RATIONALE: Orthostatic hypotension results from decreased circulating volume, which reduces
blood pressure upon position change.
QUESTION 6
When performing sterile gloving, which action by the nurse compromises sterility?
A. Touching the inner surface of the glove with bare fingers.
B. Grasping the outer cuff with the gloved hand.
C. Keeping gloved hands above the waist.
D. Checking gloves for tears.
,CORRECT ANSWER: A
RATIONALE: The inner surface may be touched only when donning the glove; touching the outer
sterile surface is a breach of technique.
QUESTION 7
A nurse is assessing a client who reports difficulty swallowing. To reduce risk of aspiration, the
nurse should:
A. Encourage rapid intake of fluids between bites.
B. Position the client in the supine position.
C. Offer thickened liquids.
D. Use a straw for all liquids.
CORRECT ANSWER: C
RATIONALE: Thickened liquids move more slowly, allowing better control of swallowing and
reducing aspiration risk.
QUESTION 8
When collecting a urine specimen from an indwelling catheter, the nurse should obtain it from:
A. The collection bag.
B. The drainage tubing port.
C. The catheter insertion site.
D. The patient’s next void.
CORRECT ANSWER: B
RATIONALE: The sample must be collected from the sampling port to avoid contamination from
stagnant urine in the bag.
QUESTION 9
A client taking a loop diuretic is at risk for which electrolyte imbalance?
A. Hypercalcemia
B. Hyponatremia
C. Hyperkalemia
D. Hypokalemia
, CORRECT ANSWER: D
RATIONALE: Loop diuretics promote potassium loss through increased urine output, often
causing hypokalemia.
QUESTION 10
A nurse is observing stages of infection. Which stage involves onset of specific symptoms?
A. Incubation
B. Prodromal
C. Illness
D. Convalescence
CORRECT ANSWER: C
RATIONALE: During the illness stage, characteristic symptoms appear, marking active infection.
QUESTION 11
A nurse is preparing to administer a subcutaneous injection. Which of the following sites is most
appropriate for adult clients?
A. Deltoid muscle
B. Scapular area
C. Abdomen
D. Vastus lateralis
CORRECT ANSWER: C
RATIONALE: The abdomen provides consistent absorption and easy access for subcutaneous
injections; other sites are used for intramuscular injections.
QUESTION 12
Which finding should alert the nurse to a possible need for suctioning in a tracheostomy client?
A. Clear breath sounds
B. Strong, dry cough
C. Audible gurgling respirations
D. Pink, moist mucosa
CORRECT ANSWER: C
RATIONALE: Gurgling indicates secretion buildup in the airway, requiring suctioning to maintain
patency and oxygenation.