JOYCE UNIVERSITY OF
NURSING EXAM 2
(NUR125 - NURSING
FUNDAMENTALS )
QUESTIONS WITH
COMPLETE SOLUTIONS
1. A nurse is teaching a client about hand hygiene. Which instruction is most
effective?
A. Wash hands for 5 seconds
B. Use alcohol-based sanitizer for visibly soiled hands
C. Wash hands for at least 20 seconds with soap and water
D. Rinse hands quickly with water only
Answer: C
Rationale: Handwashing should last at least 20 seconds using soap and water,
especially when hands are visibly soiled.
2. Which patient is at highest risk for developing pressure injuries?
A. Ambulatory client with diabetes
B. Bedbound client with incontinence
C. Post-op patient walking daily
,D. Client on a high-protein diet
Answer: B
Rationale: Immobility and moisture from incontinence significantly increase pressure
injury risk.
3. What is the priority action when a nurse finds a client unresponsive?
A. Call family
B. Check blood pressure
C. Activate emergency response system
D. Document findings
Answer: C
Rationale: Immediate activation of emergency response ensures rapid intervention.
4. Which position is best for a client experiencing difficulty breathing?
A. Supine
B. Trendelenburg
C. High Fowler’s
D. Sims’ position
Answer: C
Rationale: High Fowler’s improves lung expansion and oxygenation.
5. A nurse is assessing pain. Which is the most reliable indicator?
A. Blood pressure
B. Patient self-report
C. Facial grimacing
D. Heart rate
,Answer: B
Rationale: Pain is subjective; self-report is the gold standard.
6. What is the first step in the nursing process?
A. Diagnosis
B. Assessment
C. Planning
D. Evaluation
Answer: B
Rationale: Assessment is the foundation for all nursing care.
7. Which finding indicates hypoxia?
A. Bradycardia
B. Cyanosis
C. Hypertension
D. Warm skin
Answer: B
Rationale: Cyanosis indicates decreased oxygen in the blood.
8. A nurse is preparing to administer medication. What is the first action?
A. Give medication
B. Check allergies
C. Document administration
D. Educate patient after giving meds
Answer: B
, Rationale: Safety first—verify allergies before administration.
9. Which is a sterile procedure?
A. Bed bath
B. Urinary catheter insertion
C. Vital signs
D. Feeding a patient
Answer: B
Rationale: Catheter insertion requires sterile technique.
10. What is the normal adult respiratory rate?
A. 8–10 breaths/min
B. 12–20 breaths/min
C. 20–30 breaths/min
D. 30–40 breaths/min
Answer: B
11. A nurse hears crackles in the lungs. This may indicate:
A. Asthma
B. Fluid in alveoli
C. Pneumothorax
D. Hyperventilation
Answer: B
Rationale: Crackles often indicate fluid accumulation.
12. Which action reduces infection transmission?
NURSING EXAM 2
(NUR125 - NURSING
FUNDAMENTALS )
QUESTIONS WITH
COMPLETE SOLUTIONS
1. A nurse is teaching a client about hand hygiene. Which instruction is most
effective?
A. Wash hands for 5 seconds
B. Use alcohol-based sanitizer for visibly soiled hands
C. Wash hands for at least 20 seconds with soap and water
D. Rinse hands quickly with water only
Answer: C
Rationale: Handwashing should last at least 20 seconds using soap and water,
especially when hands are visibly soiled.
2. Which patient is at highest risk for developing pressure injuries?
A. Ambulatory client with diabetes
B. Bedbound client with incontinence
C. Post-op patient walking daily
,D. Client on a high-protein diet
Answer: B
Rationale: Immobility and moisture from incontinence significantly increase pressure
injury risk.
3. What is the priority action when a nurse finds a client unresponsive?
A. Call family
B. Check blood pressure
C. Activate emergency response system
D. Document findings
Answer: C
Rationale: Immediate activation of emergency response ensures rapid intervention.
4. Which position is best for a client experiencing difficulty breathing?
A. Supine
B. Trendelenburg
C. High Fowler’s
D. Sims’ position
Answer: C
Rationale: High Fowler’s improves lung expansion and oxygenation.
5. A nurse is assessing pain. Which is the most reliable indicator?
A. Blood pressure
B. Patient self-report
C. Facial grimacing
D. Heart rate
,Answer: B
Rationale: Pain is subjective; self-report is the gold standard.
6. What is the first step in the nursing process?
A. Diagnosis
B. Assessment
C. Planning
D. Evaluation
Answer: B
Rationale: Assessment is the foundation for all nursing care.
7. Which finding indicates hypoxia?
A. Bradycardia
B. Cyanosis
C. Hypertension
D. Warm skin
Answer: B
Rationale: Cyanosis indicates decreased oxygen in the blood.
8. A nurse is preparing to administer medication. What is the first action?
A. Give medication
B. Check allergies
C. Document administration
D. Educate patient after giving meds
Answer: B
, Rationale: Safety first—verify allergies before administration.
9. Which is a sterile procedure?
A. Bed bath
B. Urinary catheter insertion
C. Vital signs
D. Feeding a patient
Answer: B
Rationale: Catheter insertion requires sterile technique.
10. What is the normal adult respiratory rate?
A. 8–10 breaths/min
B. 12–20 breaths/min
C. 20–30 breaths/min
D. 30–40 breaths/min
Answer: B
11. A nurse hears crackles in the lungs. This may indicate:
A. Asthma
B. Fluid in alveoli
C. Pneumothorax
D. Hyperventilation
Answer: B
Rationale: Crackles often indicate fluid accumulation.
12. Which action reduces infection transmission?
