NURS100 Fundamentals of Nursing Assessment 2026 – WCU
1. Which technique is the most effective way to prevent the spread of infection?
A. Frequent hand hygiene
B. Wearing gloves at all times
C. Using antibiotic ointments
D. Administering prophylactic medications
Answer: A
Rationale: Hand hygiene is the single most important practice to reduce the transmission
of infectious agents in healthcare settings.
2. When measuring a patient’s blood pressure, where should the nurse position
the patient’s arm?
A. Resting on the floor
B. Above the level of the head
C. Hanging down by the side
D. At the level of the heart
Answer: D
Rationale: Positioning the arm at heart level ensures an accurate blood pressure reading;
an arm above heart level results in a false low, and below heart level results in a false high.
,3. A patient is experiencing shortness of breath. Which position should the
nurse place the patient in?
A. Supine
B. Prone
C. Sims’ position
D. High Fowler’s
Answer: D
Rationale: High Fowler’s position (90 degrees) allows for maximum chest expansion and
eases breathing for patients with respiratory distress.
4. What is the normal range for an adult’s resting heart rate?
A. 60-100 bpm
B. 100-120 bpm
C. 80-110 bpm
D. 40-60 bpm
Answer: A
Rationale: The standard normal resting heart rate for an adult is between 60 and 100
beats per minute.
5. Which part of a sterile field is considered contaminated?
A. The center of the sterile drape
B. The 1-inch border around the edge
C. The instruments placed in the center
D. The top surface of the sterile field
Answer: B
Rationale: In sterile technique, the outer 1-inch edge of a sterile field is considered non-
sterile or contaminated.
, 6. Which intervention is a priority for a patient at high risk for falls?
A. Keeping all four side rails up
B. Placing the call light within reach
C. Keeping the bed in the highest position
D. Administering a sedative at night
Answer: B
Rationale: Ensuring the call light is within reach allows the patient to ask for help before
attempting to get up, which is a key fall prevention strategy.
7. Which of the following is an example of objective data?
A. Patient complaining of nausea
B. Patient reporting pain at a level 5/10
C. Blood pressure reading of 140/90 mmHg
D. Patient stating they feel dizzy
Answer: C
Rationale: Objective data are observable and measurable signs, such as vital signs, while
subjective data are symptoms reported by the patient.
8. During which stage of infection is the patient most contagious?
A. Prodromal stage
B. Full stage of illness
C. Convalescent period
D. Incubation period
Answer: A
Rationale: The prodromal stage is when the patient is often most contagious because they
have early, non-specific symptoms and may not realize they are sick.
1. Which technique is the most effective way to prevent the spread of infection?
A. Frequent hand hygiene
B. Wearing gloves at all times
C. Using antibiotic ointments
D. Administering prophylactic medications
Answer: A
Rationale: Hand hygiene is the single most important practice to reduce the transmission
of infectious agents in healthcare settings.
2. When measuring a patient’s blood pressure, where should the nurse position
the patient’s arm?
A. Resting on the floor
B. Above the level of the head
C. Hanging down by the side
D. At the level of the heart
Answer: D
Rationale: Positioning the arm at heart level ensures an accurate blood pressure reading;
an arm above heart level results in a false low, and below heart level results in a false high.
,3. A patient is experiencing shortness of breath. Which position should the
nurse place the patient in?
A. Supine
B. Prone
C. Sims’ position
D. High Fowler’s
Answer: D
Rationale: High Fowler’s position (90 degrees) allows for maximum chest expansion and
eases breathing for patients with respiratory distress.
4. What is the normal range for an adult’s resting heart rate?
A. 60-100 bpm
B. 100-120 bpm
C. 80-110 bpm
D. 40-60 bpm
Answer: A
Rationale: The standard normal resting heart rate for an adult is between 60 and 100
beats per minute.
5. Which part of a sterile field is considered contaminated?
A. The center of the sterile drape
B. The 1-inch border around the edge
C. The instruments placed in the center
D. The top surface of the sterile field
Answer: B
Rationale: In sterile technique, the outer 1-inch edge of a sterile field is considered non-
sterile or contaminated.
, 6. Which intervention is a priority for a patient at high risk for falls?
A. Keeping all four side rails up
B. Placing the call light within reach
C. Keeping the bed in the highest position
D. Administering a sedative at night
Answer: B
Rationale: Ensuring the call light is within reach allows the patient to ask for help before
attempting to get up, which is a key fall prevention strategy.
7. Which of the following is an example of objective data?
A. Patient complaining of nausea
B. Patient reporting pain at a level 5/10
C. Blood pressure reading of 140/90 mmHg
D. Patient stating they feel dizzy
Answer: C
Rationale: Objective data are observable and measurable signs, such as vital signs, while
subjective data are symptoms reported by the patient.
8. During which stage of infection is the patient most contagious?
A. Prodromal stage
B. Full stage of illness
C. Convalescent period
D. Incubation period
Answer: A
Rationale: The prodromal stage is when the patient is often most contagious because they
have early, non-specific symptoms and may not realize they are sick.
