1. A nurse is preparing to assess a patient’s vital signs. Which of the following
should the nurse do first?
A) Measure the temperature
B) Measure the pulse rate
C) Measure the respiratory rate
D) Assess the blood pressure
Answer: A) Measure the temperature
Rationale: The nurse should always start with the assessment of temperature because it can
provide an initial clue to the patient’s overall condition. It is important to identify fever or
abnormal temperatures early.
2. When educating a patient about hand hygiene, the nurse should include which
of the following as an essential component?
A) Wash hands for at least 10 seconds
B) Use hot water when washing hands
C) Rub hands together for at least 20 seconds
D) Dry hands with a cloth towel after washing
Answer: C) Rub hands together for at least 20 seconds
Rationale: The Centers for Disease Control and Prevention (CDC) recommends rubbing hands
together for at least 20 seconds with soap and water to effectively remove pathogens.
3. A patient is in the recovery room after surgery and is experiencing nausea.
Which of the following actions should the nurse take first?
A) Administer an antiemetic
B) Ask the patient to breathe deeply
C) Provide a basin for vomiting
D) Assess the patient's pain level
Answer: B) Ask the patient to breathe deeply
Rationale: Deep breathing can help reduce nausea and prevent vomiting. Administering
medication should be considered if this does not alleviate the nausea.
,4. A nurse is preparing to administer a medication to a patient. Which of the
following should the nurse do first?
A) Check the patient’s allergy history
B) Check the patient’s name band
C) Verify the medication’s expiration date
D) Prepare the medication in the medication room
Answer: B) Check the patient’s name band
Rationale: The first priority when administering medication is verifying the patient’s identity to
prevent medication errors. The nurse should then follow the rights of medication administration.
5. When performing a physical assessment on a patient, the nurse should use
which of the following techniques to assess lung sounds?
A) Palpation
B) Percussion
C) Auscultation
D) Inspection
Answer: C) Auscultation
Rationale: Auscultation is the technique used to listen to lung sounds. This provides information
about the patient’s respiratory status.
6. A nurse is caring for a patient with a urinary catheter. Which of the following
actions should the nurse take to prevent a urinary tract infection (UTI)?
A) Keep the catheter bag above the level of the bladder
B) Perform catheter care daily and as needed
C) Use sterile technique for all catheter changes
D) Disconnect the catheter during bathing
Answer: B) Perform catheter care daily and as needed
Rationale: Proper catheter care is critical in preventing infections. The nurse should maintain
hygiene and ensure that the catheter is secure, with a closed system, to reduce infection risk.
, 7. The nurse is monitoring a patient who has just received a dose of IV pain
medication. Which of the following actions should the nurse take first?
A) Assess the patient’s level of pain
B) Monitor the patient’s vital signs
C) Assess the patient’s mental status
D) Educate the patient about potential side effects
Answer: B) Monitor the patient’s vital signs
Rationale: After administering pain medication, it’s essential to first monitor vital signs,
especially respiratory rate and blood pressure, to assess for any adverse effects such as
respiratory depression or hypotension.
8. A nurse is performing a wound dressing change on a patient with a surgical
incision. Which of the following actions is most important to prevent infection?
A) Use sterile technique when handling the dressing
B) Apply a thick layer of ointment around the incision
C) Teach the patient to change the dressing weekly
D) Place the soiled dressing in a regular trash bag
Answer: A) Use sterile technique when handling the dressing
Rationale: Using sterile technique minimizes the risk of introducing microorganisms into the
wound, which helps prevent infection.
9. When a nurse is assessing a patient’s nutritional status, which of the following
is the most important indicator?
A) Height and weight
B) Hemoglobin levels
C) Appetite
D) Skin turgor
Answer: A) Height and weight
Rationale: Height and weight are key indicators of nutritional status. Monitoring these
measurements helps identify undernutrition or overnutrition.
should the nurse do first?
A) Measure the temperature
B) Measure the pulse rate
C) Measure the respiratory rate
D) Assess the blood pressure
Answer: A) Measure the temperature
Rationale: The nurse should always start with the assessment of temperature because it can
provide an initial clue to the patient’s overall condition. It is important to identify fever or
abnormal temperatures early.
2. When educating a patient about hand hygiene, the nurse should include which
of the following as an essential component?
A) Wash hands for at least 10 seconds
B) Use hot water when washing hands
C) Rub hands together for at least 20 seconds
D) Dry hands with a cloth towel after washing
Answer: C) Rub hands together for at least 20 seconds
Rationale: The Centers for Disease Control and Prevention (CDC) recommends rubbing hands
together for at least 20 seconds with soap and water to effectively remove pathogens.
3. A patient is in the recovery room after surgery and is experiencing nausea.
Which of the following actions should the nurse take first?
A) Administer an antiemetic
B) Ask the patient to breathe deeply
C) Provide a basin for vomiting
D) Assess the patient's pain level
Answer: B) Ask the patient to breathe deeply
Rationale: Deep breathing can help reduce nausea and prevent vomiting. Administering
medication should be considered if this does not alleviate the nausea.
,4. A nurse is preparing to administer a medication to a patient. Which of the
following should the nurse do first?
A) Check the patient’s allergy history
B) Check the patient’s name band
C) Verify the medication’s expiration date
D) Prepare the medication in the medication room
Answer: B) Check the patient’s name band
Rationale: The first priority when administering medication is verifying the patient’s identity to
prevent medication errors. The nurse should then follow the rights of medication administration.
5. When performing a physical assessment on a patient, the nurse should use
which of the following techniques to assess lung sounds?
A) Palpation
B) Percussion
C) Auscultation
D) Inspection
Answer: C) Auscultation
Rationale: Auscultation is the technique used to listen to lung sounds. This provides information
about the patient’s respiratory status.
6. A nurse is caring for a patient with a urinary catheter. Which of the following
actions should the nurse take to prevent a urinary tract infection (UTI)?
A) Keep the catheter bag above the level of the bladder
B) Perform catheter care daily and as needed
C) Use sterile technique for all catheter changes
D) Disconnect the catheter during bathing
Answer: B) Perform catheter care daily and as needed
Rationale: Proper catheter care is critical in preventing infections. The nurse should maintain
hygiene and ensure that the catheter is secure, with a closed system, to reduce infection risk.
, 7. The nurse is monitoring a patient who has just received a dose of IV pain
medication. Which of the following actions should the nurse take first?
A) Assess the patient’s level of pain
B) Monitor the patient’s vital signs
C) Assess the patient’s mental status
D) Educate the patient about potential side effects
Answer: B) Monitor the patient’s vital signs
Rationale: After administering pain medication, it’s essential to first monitor vital signs,
especially respiratory rate and blood pressure, to assess for any adverse effects such as
respiratory depression or hypotension.
8. A nurse is performing a wound dressing change on a patient with a surgical
incision. Which of the following actions is most important to prevent infection?
A) Use sterile technique when handling the dressing
B) Apply a thick layer of ointment around the incision
C) Teach the patient to change the dressing weekly
D) Place the soiled dressing in a regular trash bag
Answer: A) Use sterile technique when handling the dressing
Rationale: Using sterile technique minimizes the risk of introducing microorganisms into the
wound, which helps prevent infection.
9. When a nurse is assessing a patient’s nutritional status, which of the following
is the most important indicator?
A) Height and weight
B) Hemoglobin levels
C) Appetite
D) Skin turgor
Answer: A) Height and weight
Rationale: Height and weight are key indicators of nutritional status. Monitoring these
measurements helps identify undernutrition or overnutrition.
