,NU 189 Exam 1 | Questions & Verified Answers | 2026
Edition | Galen College
1. Which of the following best describes the primary purpose of the nursing process?
A) To ensure all patients receive identical care
B) To provide a systematic problem-solving framework for individualized care
C) To delegate all care decisions to the physician
D) To document patient outcomes after discharge
Correct Answer: To provide a systematic problem-solving framework for individualized care
Rationale: The nursing process (ADPIE) is a critical thinking method that guides assessment, diagnosis,
planning, implementation, and evaluation. It ensures care is tailored to each patient's unique needs,
forming the foundation of clinical decision-making.
2. The nurse is caring for a patient who develops a sudden onset of dyspnea and wheezing. What should
the nurse do first?
A) Administer a bronchodilator
B) Call the health care provider
C) Assess the patient's respiratory status and vital signs
D) Document the symptoms
Correct Answer: Assess the patient's respiratory status and vital signs
Rationale: Assessment is always the first step of the nursing process. The nurse must gather objective
data such as breath sounds, oxygen saturation, and respiratory rate before implementing interventions
or notifying the provider.
3. A nursing student asks the instructor to explain "subjective data." The instructor's best response is
that subjective data are
A) observable findings such as vital signs
,B) laboratory results and diagnostic tests
C) information the patient reports, such as pain and nausea
D) data collected by the physician
Correct Answer: Information the patient reports, such as pain and nausea
Rationale: Subjective data are the patient's own descriptions of their symptoms, feelings, and
perceptions. They cannot be directly observed or measured by the nurse, unlike objective data like vital
signs, lab values, or physical exam findings.
4. Which of the following nursing actions is an independent nursing intervention?
A) Administering oral medication
B) Initiating intravenous therapy
C) Inserting a urinary catheter
D) Repositioning a patient every 2 hours
Correct Answer: Repositioning a patient every 2 hours
Rationale: Independent nursing interventions are those the nurse can initiate without a provider's order,
based on nursing knowledge and judgment. Repositioning to prevent pressure injuries is independent.
Administering medications, initiating IV therapy, and inserting catheters require orders.
5. The nurse is prioritizing patient problems using Maslow's hierarchy of needs. Which need should be
addressed first?
A) Oxygenation and airway patency
B) Self-esteem
C) Love and belonging
D) Safety from falls
Correct Answer: Oxygenation and airway patency
, Rationale: Maslow's hierarchy places physiological needs, including oxygenation, as the highest priority.
The nurse must ensure airway, breathing, and circulation are stable before addressing safety, love, or
self-esteem needs.
6. When washing hands with soap and water, the nurse should scrub for at least
A) 5 seconds
B) 20 seconds
C) 60 seconds
D) 120 seconds
Correct Answer: 20 seconds
Rationale: The Centers for Disease Control and Prevention recommends handwashing with soap and
water for at least 20 seconds to effectively remove microorganisms. Shorter times are insufficient;
longer times are not necessary for routine hand hygiene.
7. The nurse observes a coworker about to enter the room of a patient with Clostridioides difficile
infection wearing only gloves. Which action should the nurse take?
A) Allow the coworker to enter
B) Remind the coworker that a gown and soap-and-water hand hygiene are required
C) Suggest the coworker wear a mask
D) Report the coworker to the supervisor
Correct Answer: Remind the coworker that a gown and soap-and-water hand hygiene are required
Rationale: C. difficile spores are not killed by alcohol-based hand rubs. Contact precautions require
gloves and a gown, and hand hygiene must be performed with soap and water. A mask is not required
unless indicated for droplet or airborne precautions.
8. Which of the following is the most effective method to prevent health care-associated infections?
Edition | Galen College
1. Which of the following best describes the primary purpose of the nursing process?
A) To ensure all patients receive identical care
B) To provide a systematic problem-solving framework for individualized care
C) To delegate all care decisions to the physician
D) To document patient outcomes after discharge
Correct Answer: To provide a systematic problem-solving framework for individualized care
Rationale: The nursing process (ADPIE) is a critical thinking method that guides assessment, diagnosis,
planning, implementation, and evaluation. It ensures care is tailored to each patient's unique needs,
forming the foundation of clinical decision-making.
2. The nurse is caring for a patient who develops a sudden onset of dyspnea and wheezing. What should
the nurse do first?
A) Administer a bronchodilator
B) Call the health care provider
C) Assess the patient's respiratory status and vital signs
D) Document the symptoms
Correct Answer: Assess the patient's respiratory status and vital signs
Rationale: Assessment is always the first step of the nursing process. The nurse must gather objective
data such as breath sounds, oxygen saturation, and respiratory rate before implementing interventions
or notifying the provider.
3. A nursing student asks the instructor to explain "subjective data." The instructor's best response is
that subjective data are
A) observable findings such as vital signs
,B) laboratory results and diagnostic tests
C) information the patient reports, such as pain and nausea
D) data collected by the physician
Correct Answer: Information the patient reports, such as pain and nausea
Rationale: Subjective data are the patient's own descriptions of their symptoms, feelings, and
perceptions. They cannot be directly observed or measured by the nurse, unlike objective data like vital
signs, lab values, or physical exam findings.
4. Which of the following nursing actions is an independent nursing intervention?
A) Administering oral medication
B) Initiating intravenous therapy
C) Inserting a urinary catheter
D) Repositioning a patient every 2 hours
Correct Answer: Repositioning a patient every 2 hours
Rationale: Independent nursing interventions are those the nurse can initiate without a provider's order,
based on nursing knowledge and judgment. Repositioning to prevent pressure injuries is independent.
Administering medications, initiating IV therapy, and inserting catheters require orders.
5. The nurse is prioritizing patient problems using Maslow's hierarchy of needs. Which need should be
addressed first?
A) Oxygenation and airway patency
B) Self-esteem
C) Love and belonging
D) Safety from falls
Correct Answer: Oxygenation and airway patency
, Rationale: Maslow's hierarchy places physiological needs, including oxygenation, as the highest priority.
The nurse must ensure airway, breathing, and circulation are stable before addressing safety, love, or
self-esteem needs.
6. When washing hands with soap and water, the nurse should scrub for at least
A) 5 seconds
B) 20 seconds
C) 60 seconds
D) 120 seconds
Correct Answer: 20 seconds
Rationale: The Centers for Disease Control and Prevention recommends handwashing with soap and
water for at least 20 seconds to effectively remove microorganisms. Shorter times are insufficient;
longer times are not necessary for routine hand hygiene.
7. The nurse observes a coworker about to enter the room of a patient with Clostridioides difficile
infection wearing only gloves. Which action should the nurse take?
A) Allow the coworker to enter
B) Remind the coworker that a gown and soap-and-water hand hygiene are required
C) Suggest the coworker wear a mask
D) Report the coworker to the supervisor
Correct Answer: Remind the coworker that a gown and soap-and-water hand hygiene are required
Rationale: C. difficile spores are not killed by alcohol-based hand rubs. Contact precautions require
gloves and a gown, and hand hygiene must be performed with soap and water. A mask is not required
unless indicated for droplet or airborne precautions.
8. Which of the following is the most effective method to prevent health care-associated infections?
