NUR104 Exam 4 and Hesi Foundations of Nursing
Questions and Answers
Hand hygiene priority
Q: What is the most effective way to prevent hospital-acquired infections?
A: Handwashing with soap and water.
Rationale: Alcohol rubs are useful, but handwashing removes spores (e.g., C. diff).
Pressure injury risk
Q: Which patient is at greatest risk for pressure injuries?
A: Immobile, incontinent patient.
Rationale: Moisture + immobility = highest risk.
Sterile field contamination
Q: What contaminates a sterile field?
A: Reaching across the field.
Rationale: Movement introduces microorganisms.
Ear drops administration
Q: How are ear drops administered to an adult?
A: Pull pinna up and back.
Insulin mixing order
Q: Which insulin is drawn first when mixing?
A: Regular (clear) before NPH (cloudy).
NG tube medication
Q: What is the correct step before giving meds via NG tube?
A: Flush with water.
Blood transfusion reaction
Q: Early signs of transfusion reaction?
A: Chills, fever, low back pain.
COPD positioning
Q: Best position for COPD patient in distress?
A: High Fowler’s.
Restraint use
Q: When are restraints appropriate?
A: Only when patient safety cannot be maintained otherwise.
Therapeutic communication
Q: Which statement is therapeutic?
A: “Tell me more about how you’re feeling.”
, Informed consent
Q: Who explains the procedure before consent?
A: The surgeon.
Delegation to UAP
Q: Which task can be delegated to UAP?
A: Assisting stable patient with bathing.
Enoxaparin injection
Q: Correct technique for enoxaparin?
A: Subcutaneous, pinch skin, no aspiration.
Burn patient priority
Q: First priority in burn patient care?
A: Hand hygiene before wound care.
Ice chips intake
Q: 240 mL ice chips = ? intake
A: 120 mL.
Wound healing nutrition
Q: Which nutrient supports wound healing?
A: Protein.
Fall prevention
Q: Best intervention for fall risk patient?
A: Remove clutter and use night lights.
Tuberculin test angle
Q: At what angle is a TB test given?
A: 5–15° intradermal.
Urinary catheter care
Q: How to prevent infection with catheter?
A: Keep drainage bag below bladder level.
Oxygen safety
Q: What is prohibited near oxygen?
A: Smoking.
Delegation after surgery
Q: Can UAP ambulate a fresh post-op patient?
A: No, requires RN assessment first.
NG tube placement check
Questions and Answers
Hand hygiene priority
Q: What is the most effective way to prevent hospital-acquired infections?
A: Handwashing with soap and water.
Rationale: Alcohol rubs are useful, but handwashing removes spores (e.g., C. diff).
Pressure injury risk
Q: Which patient is at greatest risk for pressure injuries?
A: Immobile, incontinent patient.
Rationale: Moisture + immobility = highest risk.
Sterile field contamination
Q: What contaminates a sterile field?
A: Reaching across the field.
Rationale: Movement introduces microorganisms.
Ear drops administration
Q: How are ear drops administered to an adult?
A: Pull pinna up and back.
Insulin mixing order
Q: Which insulin is drawn first when mixing?
A: Regular (clear) before NPH (cloudy).
NG tube medication
Q: What is the correct step before giving meds via NG tube?
A: Flush with water.
Blood transfusion reaction
Q: Early signs of transfusion reaction?
A: Chills, fever, low back pain.
COPD positioning
Q: Best position for COPD patient in distress?
A: High Fowler’s.
Restraint use
Q: When are restraints appropriate?
A: Only when patient safety cannot be maintained otherwise.
Therapeutic communication
Q: Which statement is therapeutic?
A: “Tell me more about how you’re feeling.”
, Informed consent
Q: Who explains the procedure before consent?
A: The surgeon.
Delegation to UAP
Q: Which task can be delegated to UAP?
A: Assisting stable patient with bathing.
Enoxaparin injection
Q: Correct technique for enoxaparin?
A: Subcutaneous, pinch skin, no aspiration.
Burn patient priority
Q: First priority in burn patient care?
A: Hand hygiene before wound care.
Ice chips intake
Q: 240 mL ice chips = ? intake
A: 120 mL.
Wound healing nutrition
Q: Which nutrient supports wound healing?
A: Protein.
Fall prevention
Q: Best intervention for fall risk patient?
A: Remove clutter and use night lights.
Tuberculin test angle
Q: At what angle is a TB test given?
A: 5–15° intradermal.
Urinary catheter care
Q: How to prevent infection with catheter?
A: Keep drainage bag below bladder level.
Oxygen safety
Q: What is prohibited near oxygen?
A: Smoking.
Delegation after surgery
Q: Can UAP ambulate a fresh post-op patient?
A: No, requires RN assessment first.
NG tube placement check
