2024/2025 REAL EXAM QUESTIONS AND
CORRECT ANSWERS
Nursing assistant cannot do anything with: - ANSWER>>>assessing, change
dressing or wounds, no
teaching
Which patient would you assess first: - ANSWER>>>1st-Which patient can I look at
and they will die if I don't do something?
2nd-Most critical state
3rd-ABC
4th-SOB you should be very concerned
Triaging colors: Green, Yellow, Red, Black - ANSWER>>>-(not urgent, can get up
and walk)
-(not life threatening, can be treated within 30min-2hours)
-(highest priority, respiratory issues, Loss of consciousness)
-(dead)
1. A policy requiring the removal of acrylic nails by all nursing personnel was
implemented 6
months ago. Which assessment measure best determines if the intended
outcome of the policy is
being achieved?
a. Number of staff induced injury
,b. Client satisfaction survey
c. Health care-associated infection rate.
d. Rate of needle-stick injuries by nurse. - ANSWER>>>(C)--Acrylic nails are known
to carry loads of bacteria and increase the risk of healthcare-associated
infections. Therefore, by banning the wearing of acrylic nails, you would expect
the prevalence
of healthcare-associated infections to decrease. Acrylic nails have nothing to do
with staff
induced injuries, needle-stick injuries, or patient satisfaction scores.
2. Which assessment data would provide the most accurate determination of
proper placement of
a nasogastric tube?
A) Aspirating gastric contents to assure a pH value of 4 or less.
B) Hearing air pass in the stomach after injecting air into the tubing.
C) Examining a chest x-ray obtained after the tubing was inserted.
D) Checking the remaining length of tubing to ensure that the correct length was
inserted.
A) Aspirating gastric contents to assure a pH value of 4 or less. - ANSWER>>>(c)--
This is a method used to determine proper placement of NG tubing, but not the
most accurate.
B) Hearing air pass in the stomach after injecting air into the tubing.
This is a method used to determine proper placement of NG tubing, but not the
most accurate.
C) Examining a chest x-ray obtained after the tubing was inserted.
,After placing an NG-tube, the placement of the tube is confirmed via x-ray since it
is the most
accurate way to ensure the tube has not been placed in the lungs, which would
pose an aspiration
risk.
D) Checking the remaining length of tubing to ensure that the correct length was
inserted.
This is not an indicator of proper placement. You could very well be in a lung.
3. The father of an 11-year-old client reports to the nurse that the client has been
"wetting the
bed" since the passing of his mother and is concerned. Which action is most
important for the
nurse to enact?
A. Reassure the father that it is normal for a pre-teen to wet the bed during
puberty
B. Inform the father that nocturnal emissions are abnormal and his son is
developmentally
delayed
C. Inform the father that it is most important to let the son know that nocturnal
emissions are
normal after trauma
D. Refer the father and the client to a psychologist - ANSWER>>>(c) --It is common
for adolescents to regress in their biological progression after experiencing a
severe
, trauma, like losing a parent, sibling, or friend. While uncomfortable for the
adolescent and
parent, it is nothing to be concerned for. Often times, as the patient grieves or
comes to terms
with the trauma, the nocturnal emissions will cease.
4. The nurse explains to an older adult male the procedure for collecting a 24-
hour urine
specimen for creatinine clearance. Which action is most important for the nurse
to include in
their care plan for the shift?
A. Assess the client for confusion and reteach the procedure
B. Check the urine for color and texture
C. Empty the urinal contents into the 24-hour collection container
D. Discard the contents of the urinal - ANSWER>>>(c)--An "older adult male" in
the question may imply that the patient may have an altered mental
status or be demented. While suggesting, it is not directly stated, therefore (A) is
inappropriate.
(B) is incorrect because the lab will be assessing the collection specimen after the
test is
complete. (C) is correct because the nurse should first discard the first specimen,
then begin to
collect and record the time the first urine specimen was collected. It is important
to have strict