NUR 195 Exam 3 Practice Questions with
Answers and Rationales Latest Version A+.
Question 1
Which action is most effective in preventing the spread of infection?
A. Wearing gloves at all times
B. Performing hand hygiene before and after patient contact
C. Using antibiotics routinely
D. Keeping patients isolated
Answer: B. Performing hand hygiene before and after patient contact
Rationale:
Hand hygiene is the most important method for preventing transmission of microorganisms in
healthcare settings.
Question 2
A nurse is preparing to administer medication to a patient. Which action best demonstrates safe
medication practice?
A. Checking the medication label once before administration
B. Asking another nurse to give the medication
C. Verifying the medication using the rights of medication administration
D. Giving medications prepared by another nurse
Answer: C. Verifying the medication using the rights of medication administration
Rationale:
The nurse should follow medication rights, including the right patient, medication, dose, route,
time, documentation, reason, and response (depending on facility policy). This reduces
medication errors.
Question 3
A patient tells the nurse, “I am scared about my upcoming surgery.” Which response
demonstrates therapeutic communication?
,A. “Don’t worry; everything will be fine.”
B. “Why are you scared?”
C. “Tell me what concerns you most about your surgery.”
D. “You should focus on getting better.”
Answer: C. “Tell me what concerns you most about your surgery.”
Rationale:
Open-ended statements encourage patients to express feelings and allow the nurse to assess
concerns. False reassurance can block communication.
Question 4
The nurse is caring for a patient with a fever. Which intervention is appropriate?
A. Provide extra blankets
B. Encourage fluids if not contraindicated
C. Restrict oral intake
D. Keep the room warm
Answer: B. Encourage fluids if not contraindicated
Rationale:
Fever increases fluid loss through sweating and increased metabolism. Fluids help prevent
dehydration. Cooling measures may also be used depending on the situation.
Question 5
A nurse is documenting patient care. Which documentation entry is appropriate?
A. “Patient seems better today.”
B. “Patient had a good day.”
C. “Patient ambulated 50 feet with assistance and denied dizziness.”
D. “Patient was difficult.”
Answer: C. “Patient ambulated 50 feet with assistance and denied dizziness.”
Rationale:
Documentation should be objective, specific, and measurable. Avoid opinions or vague
statements.
,Question 6\
A nurse enters a patient’s room and notices the patient is confused, attempting to get out of bed,
and has an unsteady gait. What is the nurse’s priority action?
A. Apply physical restraints
B. Place the patient in a low bed position and activate fall precautions
C. Ask the family to stay with the patient
D. Administer a sedative medication
Answer: B. Place the patient in a low bed position and activate fall precautions
Rationale:
The priority is preventing injury while maintaining patient safety. Fall precautions include
lowering the bed, ensuring the call light is available, removing hazards, and providing assistance
with ambulation. Restraints are a last resort and require proper assessment and orders.
Question 7
A nurse is assessing a patient’s respiratory status. Which finding requires immediate attention?
A. Respiratory rate of 16/min
B. Oxygen saturation of 88%
C. Temperature of 37°C (98.6°F)
D. Heart rate of 78/min
Answer: B. Oxygen saturation of 88%
Rationale:
Low oxygen saturation indicates impaired oxygenation and requires prompt intervention and
further assessment.
Question 8
A patient refuses a prescribed treatment. What should the nurse do first?
A. Tell the patient they must comply
B. Notify security
C. Assess the reason for refusal
D. Document refusal only
, Answer: C. Assess the reason for refusal
Rationale:
Patients have the right to refuse care. The nurse should determine the reason, provide education,
and document the decision.
Question 9
Which position is best for a patient experiencing difficulty breathing?
A. Supine
B. Trendelenburg
C. High Fowler’s position
D. Prone
Answer: C. High Fowler’s position
Rationale:
High Fowler’s allows maximum lung expansion and improves ventilation.
Question 10
A nurse notices a patient has redness over the sacral area. What is the priority nursing
intervention?
A. Massage the reddened area
B. Apply pressure to the area
C. Reposition the patient and reduce pressure
D. Cover the area with a blanket
Answer: C. Reposition the patient and reduce pressure
Rationale:
Redness may indicate early pressure injury. Removing pressure prevents worsening tissue
damage. Massaging reddened areas can increase injury.
Question 11
A nurse is caring for a patient who has a urinary catheter. Which action helps prevent catheter-
associated urinary tract infection (CAUTI)?
Answers and Rationales Latest Version A+.
Question 1
Which action is most effective in preventing the spread of infection?
A. Wearing gloves at all times
B. Performing hand hygiene before and after patient contact
C. Using antibiotics routinely
D. Keeping patients isolated
Answer: B. Performing hand hygiene before and after patient contact
Rationale:
Hand hygiene is the most important method for preventing transmission of microorganisms in
healthcare settings.
Question 2
A nurse is preparing to administer medication to a patient. Which action best demonstrates safe
medication practice?
A. Checking the medication label once before administration
B. Asking another nurse to give the medication
C. Verifying the medication using the rights of medication administration
D. Giving medications prepared by another nurse
Answer: C. Verifying the medication using the rights of medication administration
Rationale:
The nurse should follow medication rights, including the right patient, medication, dose, route,
time, documentation, reason, and response (depending on facility policy). This reduces
medication errors.
Question 3
A patient tells the nurse, “I am scared about my upcoming surgery.” Which response
demonstrates therapeutic communication?
,A. “Don’t worry; everything will be fine.”
B. “Why are you scared?”
C. “Tell me what concerns you most about your surgery.”
D. “You should focus on getting better.”
Answer: C. “Tell me what concerns you most about your surgery.”
Rationale:
Open-ended statements encourage patients to express feelings and allow the nurse to assess
concerns. False reassurance can block communication.
Question 4
The nurse is caring for a patient with a fever. Which intervention is appropriate?
A. Provide extra blankets
B. Encourage fluids if not contraindicated
C. Restrict oral intake
D. Keep the room warm
Answer: B. Encourage fluids if not contraindicated
Rationale:
Fever increases fluid loss through sweating and increased metabolism. Fluids help prevent
dehydration. Cooling measures may also be used depending on the situation.
Question 5
A nurse is documenting patient care. Which documentation entry is appropriate?
A. “Patient seems better today.”
B. “Patient had a good day.”
C. “Patient ambulated 50 feet with assistance and denied dizziness.”
D. “Patient was difficult.”
Answer: C. “Patient ambulated 50 feet with assistance and denied dizziness.”
Rationale:
Documentation should be objective, specific, and measurable. Avoid opinions or vague
statements.
,Question 6\
A nurse enters a patient’s room and notices the patient is confused, attempting to get out of bed,
and has an unsteady gait. What is the nurse’s priority action?
A. Apply physical restraints
B. Place the patient in a low bed position and activate fall precautions
C. Ask the family to stay with the patient
D. Administer a sedative medication
Answer: B. Place the patient in a low bed position and activate fall precautions
Rationale:
The priority is preventing injury while maintaining patient safety. Fall precautions include
lowering the bed, ensuring the call light is available, removing hazards, and providing assistance
with ambulation. Restraints are a last resort and require proper assessment and orders.
Question 7
A nurse is assessing a patient’s respiratory status. Which finding requires immediate attention?
A. Respiratory rate of 16/min
B. Oxygen saturation of 88%
C. Temperature of 37°C (98.6°F)
D. Heart rate of 78/min
Answer: B. Oxygen saturation of 88%
Rationale:
Low oxygen saturation indicates impaired oxygenation and requires prompt intervention and
further assessment.
Question 8
A patient refuses a prescribed treatment. What should the nurse do first?
A. Tell the patient they must comply
B. Notify security
C. Assess the reason for refusal
D. Document refusal only
, Answer: C. Assess the reason for refusal
Rationale:
Patients have the right to refuse care. The nurse should determine the reason, provide education,
and document the decision.
Question 9
Which position is best for a patient experiencing difficulty breathing?
A. Supine
B. Trendelenburg
C. High Fowler’s position
D. Prone
Answer: C. High Fowler’s position
Rationale:
High Fowler’s allows maximum lung expansion and improves ventilation.
Question 10
A nurse notices a patient has redness over the sacral area. What is the priority nursing
intervention?
A. Massage the reddened area
B. Apply pressure to the area
C. Reposition the patient and reduce pressure
D. Cover the area with a blanket
Answer: C. Reposition the patient and reduce pressure
Rationale:
Redness may indicate early pressure injury. Removing pressure prevents worsening tissue
damage. Massaging reddened areas can increase injury.
Question 11
A nurse is caring for a patient who has a urinary catheter. Which action helps prevent catheter-
associated urinary tract infection (CAUTI)?
