NU131 Exam 2 — Nursing and Healthcare I 2026/2027
NU131 EXAM 2 — NURSING AND HEALTHCARE I
Comprehensive Foundational Nursing Practice Competency Assessment
75 Questions | Testing Time: 90–120 Minutes | Passing Score: 75–80%
2026/2027 Academic Year
Instructions: This examination consists of 75 multiple-choice and select-all-that-apply questions designed to
assess foundational nursing competencies across ten clinical domains. Read each question carefully and
select the best answer or answers as indicated. For select-all-that-apply questions, more than one option may
be correct. All answers should be based on current evidence-based nursing practice, QSEN competencies,
and NCSBN Clinical Judgment Model standards. Manage your time efficiently, approximately 1.5 minutes
per question. Review all answers before submitting your examination. No electronic devices are permitted
during the test.
Domain 1: Fundamental Nursing Skills (Questions 1–8)
1. The nurse is assessing an adult patient's vital signs. Which of the following temperature
readings is within the normal range for an adult?
A. 97.0°F (36.1°C)
B. 97.8°F (36.5°C)
C. 99.5°F (37.5°C)
D. 100.4°F (38.0°C)
Correct Answer: B
Rationale: The normal body temperature range for an adult is 97.8–99.1°F (36.5–37.3°C). A reading of
97.8°F falls at the lower end of normal. Option A is below normal (hypothermia range), while options C
and D exceed the normal range and indicate fever. Temperature can vary based on the route of
measurement, with rectal temperatures typically 0.5–1.0°F higher than oral readings.
2. When measuring blood pressure, the nurse auscultates the first clear tapping sound at 118
mmHg and the point at which the sound disappears at 74 mmHg. How should the nurse
document this reading?
A. 118/74 mmHg
B. 74/118 mmHg
C. 118/74 mmHg with auscultatory gap
D. 118/74 mmHg, Phase I through Phase V
Correct Answer: A
Rationale: The first clear tapping sound corresponds to Korotkoff Phase I and represents the systolic
pressure (118 mmHg). The point at which the sound disappears corresponds to Korotkoff Phase V and
represents the diastolic pressure (74 mmHg). Blood pressure is documented as systolic/diastolic. An
auscultatory gap would involve a temporary disappearance of sound between systolic and diastolic, which
is not described here. Phase notation is not standard documentation.
3. A patient has a radial pulse rate of 52 bpm and an apical pulse rate of 68 bpm. What is the
pulse deficit, and what does it indicate?
A. 16 bpm; indicates the heart is not contracting effectively with each beat
B. 16 bpm; indicates normal sinus rhythm
C. 8 bpm; indicates adequate cardiac output
D. 20 bpm; indicates hypertension
Correct Answer: A
Rationale: The pulse deficit is calculated as the difference between the apical pulse rate and the radial pulse
rate: 68 − 52 = 16 bpm. A pulse deficit indicates that not every ventricular contraction is producing a
palpable peripheral pulse, suggesting the heart is not contracting effectively with each beat. This finding is
commonly associated with dysrhythmias such as atrial fibrillation and requires further assessment and
provider notification.
4. Which of the following is the most accurate method for measuring core body temperature
in an adult patient?
A. Oral thermometry
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, NU131 Exam 2 — Nursing and Healthcare I 2026/2027
B. Tympanic thermometry
C. Axillary thermometry
D. Temporal artery thermometry
Correct Answer: B
Rationale: Tympanic thermometry measures temperature from the tympanic membrane, which shares its
blood supply with the hypothalamus—the body's thermoregulatory center—making it a reliable indicator of
core body temperature. Oral thermometry is affected by recent intake of hot or cold fluids. Axillary
thermometry measures skin surface temperature and is the least accurate route. Temporal artery
thermometry, while convenient, measures surface temperature and may be affected by perspiration.
5. The nurse assesses a patient's blood pressure in both arms. The reading in the right arm is
128/82 mmHg and in the left arm is 140/90 mmHg. What is the most appropriate nursing
action?
A. Document both readings and use the lower reading as the baseline
B. Document both readings and notify the healthcare provider of the discrepancy
C. Retake the blood pressure in the left arm after 5 minutes and document only that reading
D. Average the two readings and document the result
Correct Answer: B
Rationale: A difference of more than 10 mmHg in systolic blood pressure between arms may indicate
arterial obstruction, coarctation of the aorta, or other vascular abnormalities. The nurse should document
both readings and notify the healthcare provider of the discrepancy for further evaluation. Using the lower
reading, rechecking only one arm, or averaging the readings would miss a potentially significant clinical
finding. This finding aligns with QSEN safety competencies requiring accurate identification of changes in
patient status.
6. A patient complains of dizziness when moving from a lying to a sitting position. The nurse
suspects orthostatic hypotension. Which sequence of actions should the nurse follow to
assess for this condition?
A. Measure blood pressure while lying, then immediately while standing, then while sitting
B. Measure blood pressure and pulse while lying (1–3 min), then sitting (1–3 min), then standing (1–3
min)
C. Measure blood pressure and pulse while standing, then sitting, then lying
D. Measure blood pressure and pulse only in the standing position after 5 minutes of rest
Correct Answer: B
Rationale: Orthostatic hypotension is assessed by measuring blood pressure and pulse in three positions:
lying (after 1–3 minutes of rest), sitting (after 1–3 minutes), and standing (after 1–3 minutes). A drop of 20
mmHg or more in systolic pressure or 10 mmHg or more in diastolic pressure, accompanied by an increase
in heart rate, indicates orthostatic hypotension. The correct sequence is supine to sitting to standing,
allowing adequate time for hemodynamic stabilization between measurements.
7. When measuring a patient's respiratory rate, which technique is most appropriate?
A. Inform the patient that you are counting their breaths to ensure cooperation
B. Count respirations while appearing to take the radial pulse, without informing the patient
C. Ask the patient to breathe normally while you count for 15 seconds and multiply by 4
D. Observe the patient's chest from across the room and count for 30 seconds
Correct Answer: B
Rationale: The most accurate method for measuring respiratory rate is to count respirations while
maintaining the hand on the radial pulse, without informing the patient that respirations are being
assessed. Conscious awareness of respirations can alter the breathing pattern, making the count
inaccurate. Counting for a full 60 seconds is recommended for accuracy, especially if the rate is irregular.
Counting for 15 seconds may introduce error, particularly with irregular rhythms. Close observation is
preferred over distant observation for accuracy.
8. A patient's oxygen saturation (SpO2) reads 89% on room air. Which of the following
actions should the nurse take first?
A. Reposition the pulse oximeter probe on a different finger
B. Notify the healthcare provider immediately
C. Assess the patient for signs of respiratory distress and verify the reading
D. Apply supplemental oxygen at 2 L/min via nasal cannula
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, NU131 Exam 2 — Nursing and Healthcare I 2026/2027
Correct Answer: C
Rationale: An SpO2 of 89% is below the normal range of 95–100% and indicates hypoxemia. The nurse
should first assess the patient for signs of respiratory distress (e.g., dyspnea, use of accessory muscles,
altered mental status) and verify the reading by checking probe placement, patient movement, and
peripheral perfusion. While repositioning the probe (option A) may be needed, a full assessment takes
priority. Notifying the provider (option B) and applying oxygen (option D) may be necessary but should
follow assessment to determine the cause and severity of the hypoxemia.
Domain 2: Patient Safety & Infection Control (Questions 9–16)
9. The nurse is about to perform hand hygiene before a sterile procedure. According to CDC
and WHO guidelines, when should the nurse use soap and water rather than an alcohol-based
hand rub?
A. When hands are visibly soiled with blood or body fluids
B. Before every patient contact
C. After removing gloves
D. Before donning sterile gloves
Correct Answer: A
Rationale: According to CDC and WHO guidelines, alcohol-based hand rubs are effective for routine hand
decontamination but are not appropriate when hands are visibly soiled with blood, body fluids, or dirt. In
these cases, soap and water must be used because alcohol-based rubs cannot penetrate organic material.
For options B, C, and D, alcohol-based hand rubs are acceptable unless visible soilage is present.
Additionally, soap and water should be used when caring for patients with Clostridioides difficile infection,
as alcohol does not destroy C. difficile spores.
10. Place the following steps of donning personal protective equipment (PPE) in the correct
order: (1) Put on gown, (2) Put on mask/respirator, (3) Put on goggles or face shield, (4) Put
on gloves.
A. 1, 2, 3, 4
B. 2, 1, 4, 3
C. 1, 4, 2, 3
D. 2, 3, 1, 4
Correct Answer: A
Rationale: The correct sequence for donning PPE is: (1) gown, (2) mask or respirator, (3) goggles or face
shield, and (4) gloves. This sequence ensures that each piece of equipment is put on in a logical order—the
gown covers the body first, the mask protects the mucous membranes of the nose and mouth, the goggles
protect the eyes, and gloves are put on last so they can be pulled over the gown cuffs to create a seal. This is
consistent with CDC guidelines and is a critical patient safety competency aligned with QSEN safety
standards.
11. A patient is on contact precautions for MRSA. Which of the following PPE items is
required when entering the patient's room?
A. Gloves only
B. Gown and gloves
C. Gown, gloves, and N95 respirator
D. Gown, gloves, and surgical mask
Correct Answer: B
Rationale: Contact precautions require the use of a gown and gloves when entering the room of a patient
with MRSA. Contact precautions are used for infections transmitted by direct or indirect contact with the
patient or the patient's environment. An N95 respirator is required for airborne precautions (e.g.,
tuberculosis), not contact precautions. A surgical mask is used for droplet precautions. Gloves alone are
insufficient because the gown is needed to protect clothing and skin from contamination.
12. The nurse is caring for a patient on airborne precautions for pulmonary tuberculosis.
Which type of room is most appropriate for this patient?
A. A private room with the door open and a standard HVAC system
B. A private room with negative air pressure and at least 6–12 air exchanges per hour
C. A semi-private room with a portable HEPA filter
D. A private room with positive air pressure
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NU131 EXAM 2 — NURSING AND HEALTHCARE I
Comprehensive Foundational Nursing Practice Competency Assessment
75 Questions | Testing Time: 90–120 Minutes | Passing Score: 75–80%
2026/2027 Academic Year
Instructions: This examination consists of 75 multiple-choice and select-all-that-apply questions designed to
assess foundational nursing competencies across ten clinical domains. Read each question carefully and
select the best answer or answers as indicated. For select-all-that-apply questions, more than one option may
be correct. All answers should be based on current evidence-based nursing practice, QSEN competencies,
and NCSBN Clinical Judgment Model standards. Manage your time efficiently, approximately 1.5 minutes
per question. Review all answers before submitting your examination. No electronic devices are permitted
during the test.
Domain 1: Fundamental Nursing Skills (Questions 1–8)
1. The nurse is assessing an adult patient's vital signs. Which of the following temperature
readings is within the normal range for an adult?
A. 97.0°F (36.1°C)
B. 97.8°F (36.5°C)
C. 99.5°F (37.5°C)
D. 100.4°F (38.0°C)
Correct Answer: B
Rationale: The normal body temperature range for an adult is 97.8–99.1°F (36.5–37.3°C). A reading of
97.8°F falls at the lower end of normal. Option A is below normal (hypothermia range), while options C
and D exceed the normal range and indicate fever. Temperature can vary based on the route of
measurement, with rectal temperatures typically 0.5–1.0°F higher than oral readings.
2. When measuring blood pressure, the nurse auscultates the first clear tapping sound at 118
mmHg and the point at which the sound disappears at 74 mmHg. How should the nurse
document this reading?
A. 118/74 mmHg
B. 74/118 mmHg
C. 118/74 mmHg with auscultatory gap
D. 118/74 mmHg, Phase I through Phase V
Correct Answer: A
Rationale: The first clear tapping sound corresponds to Korotkoff Phase I and represents the systolic
pressure (118 mmHg). The point at which the sound disappears corresponds to Korotkoff Phase V and
represents the diastolic pressure (74 mmHg). Blood pressure is documented as systolic/diastolic. An
auscultatory gap would involve a temporary disappearance of sound between systolic and diastolic, which
is not described here. Phase notation is not standard documentation.
3. A patient has a radial pulse rate of 52 bpm and an apical pulse rate of 68 bpm. What is the
pulse deficit, and what does it indicate?
A. 16 bpm; indicates the heart is not contracting effectively with each beat
B. 16 bpm; indicates normal sinus rhythm
C. 8 bpm; indicates adequate cardiac output
D. 20 bpm; indicates hypertension
Correct Answer: A
Rationale: The pulse deficit is calculated as the difference between the apical pulse rate and the radial pulse
rate: 68 − 52 = 16 bpm. A pulse deficit indicates that not every ventricular contraction is producing a
palpable peripheral pulse, suggesting the heart is not contracting effectively with each beat. This finding is
commonly associated with dysrhythmias such as atrial fibrillation and requires further assessment and
provider notification.
4. Which of the following is the most accurate method for measuring core body temperature
in an adult patient?
A. Oral thermometry
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, NU131 Exam 2 — Nursing and Healthcare I 2026/2027
B. Tympanic thermometry
C. Axillary thermometry
D. Temporal artery thermometry
Correct Answer: B
Rationale: Tympanic thermometry measures temperature from the tympanic membrane, which shares its
blood supply with the hypothalamus—the body's thermoregulatory center—making it a reliable indicator of
core body temperature. Oral thermometry is affected by recent intake of hot or cold fluids. Axillary
thermometry measures skin surface temperature and is the least accurate route. Temporal artery
thermometry, while convenient, measures surface temperature and may be affected by perspiration.
5. The nurse assesses a patient's blood pressure in both arms. The reading in the right arm is
128/82 mmHg and in the left arm is 140/90 mmHg. What is the most appropriate nursing
action?
A. Document both readings and use the lower reading as the baseline
B. Document both readings and notify the healthcare provider of the discrepancy
C. Retake the blood pressure in the left arm after 5 minutes and document only that reading
D. Average the two readings and document the result
Correct Answer: B
Rationale: A difference of more than 10 mmHg in systolic blood pressure between arms may indicate
arterial obstruction, coarctation of the aorta, or other vascular abnormalities. The nurse should document
both readings and notify the healthcare provider of the discrepancy for further evaluation. Using the lower
reading, rechecking only one arm, or averaging the readings would miss a potentially significant clinical
finding. This finding aligns with QSEN safety competencies requiring accurate identification of changes in
patient status.
6. A patient complains of dizziness when moving from a lying to a sitting position. The nurse
suspects orthostatic hypotension. Which sequence of actions should the nurse follow to
assess for this condition?
A. Measure blood pressure while lying, then immediately while standing, then while sitting
B. Measure blood pressure and pulse while lying (1–3 min), then sitting (1–3 min), then standing (1–3
min)
C. Measure blood pressure and pulse while standing, then sitting, then lying
D. Measure blood pressure and pulse only in the standing position after 5 minutes of rest
Correct Answer: B
Rationale: Orthostatic hypotension is assessed by measuring blood pressure and pulse in three positions:
lying (after 1–3 minutes of rest), sitting (after 1–3 minutes), and standing (after 1–3 minutes). A drop of 20
mmHg or more in systolic pressure or 10 mmHg or more in diastolic pressure, accompanied by an increase
in heart rate, indicates orthostatic hypotension. The correct sequence is supine to sitting to standing,
allowing adequate time for hemodynamic stabilization between measurements.
7. When measuring a patient's respiratory rate, which technique is most appropriate?
A. Inform the patient that you are counting their breaths to ensure cooperation
B. Count respirations while appearing to take the radial pulse, without informing the patient
C. Ask the patient to breathe normally while you count for 15 seconds and multiply by 4
D. Observe the patient's chest from across the room and count for 30 seconds
Correct Answer: B
Rationale: The most accurate method for measuring respiratory rate is to count respirations while
maintaining the hand on the radial pulse, without informing the patient that respirations are being
assessed. Conscious awareness of respirations can alter the breathing pattern, making the count
inaccurate. Counting for a full 60 seconds is recommended for accuracy, especially if the rate is irregular.
Counting for 15 seconds may introduce error, particularly with irregular rhythms. Close observation is
preferred over distant observation for accuracy.
8. A patient's oxygen saturation (SpO2) reads 89% on room air. Which of the following
actions should the nurse take first?
A. Reposition the pulse oximeter probe on a different finger
B. Notify the healthcare provider immediately
C. Assess the patient for signs of respiratory distress and verify the reading
D. Apply supplemental oxygen at 2 L/min via nasal cannula
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, NU131 Exam 2 — Nursing and Healthcare I 2026/2027
Correct Answer: C
Rationale: An SpO2 of 89% is below the normal range of 95–100% and indicates hypoxemia. The nurse
should first assess the patient for signs of respiratory distress (e.g., dyspnea, use of accessory muscles,
altered mental status) and verify the reading by checking probe placement, patient movement, and
peripheral perfusion. While repositioning the probe (option A) may be needed, a full assessment takes
priority. Notifying the provider (option B) and applying oxygen (option D) may be necessary but should
follow assessment to determine the cause and severity of the hypoxemia.
Domain 2: Patient Safety & Infection Control (Questions 9–16)
9. The nurse is about to perform hand hygiene before a sterile procedure. According to CDC
and WHO guidelines, when should the nurse use soap and water rather than an alcohol-based
hand rub?
A. When hands are visibly soiled with blood or body fluids
B. Before every patient contact
C. After removing gloves
D. Before donning sterile gloves
Correct Answer: A
Rationale: According to CDC and WHO guidelines, alcohol-based hand rubs are effective for routine hand
decontamination but are not appropriate when hands are visibly soiled with blood, body fluids, or dirt. In
these cases, soap and water must be used because alcohol-based rubs cannot penetrate organic material.
For options B, C, and D, alcohol-based hand rubs are acceptable unless visible soilage is present.
Additionally, soap and water should be used when caring for patients with Clostridioides difficile infection,
as alcohol does not destroy C. difficile spores.
10. Place the following steps of donning personal protective equipment (PPE) in the correct
order: (1) Put on gown, (2) Put on mask/respirator, (3) Put on goggles or face shield, (4) Put
on gloves.
A. 1, 2, 3, 4
B. 2, 1, 4, 3
C. 1, 4, 2, 3
D. 2, 3, 1, 4
Correct Answer: A
Rationale: The correct sequence for donning PPE is: (1) gown, (2) mask or respirator, (3) goggles or face
shield, and (4) gloves. This sequence ensures that each piece of equipment is put on in a logical order—the
gown covers the body first, the mask protects the mucous membranes of the nose and mouth, the goggles
protect the eyes, and gloves are put on last so they can be pulled over the gown cuffs to create a seal. This is
consistent with CDC guidelines and is a critical patient safety competency aligned with QSEN safety
standards.
11. A patient is on contact precautions for MRSA. Which of the following PPE items is
required when entering the patient's room?
A. Gloves only
B. Gown and gloves
C. Gown, gloves, and N95 respirator
D. Gown, gloves, and surgical mask
Correct Answer: B
Rationale: Contact precautions require the use of a gown and gloves when entering the room of a patient
with MRSA. Contact precautions are used for infections transmitted by direct or indirect contact with the
patient or the patient's environment. An N95 respirator is required for airborne precautions (e.g.,
tuberculosis), not contact precautions. A surgical mask is used for droplet precautions. Gloves alone are
insufficient because the gown is needed to protect clothing and skin from contamination.
12. The nurse is caring for a patient on airborne precautions for pulmonary tuberculosis.
Which type of room is most appropriate for this patient?
A. A private room with the door open and a standard HVAC system
B. A private room with negative air pressure and at least 6–12 air exchanges per hour
C. A semi-private room with a portable HEPA filter
D. A private room with positive air pressure
3
