Fundamentals of Nursing Exam 1 (50 Items)

All questions and answers are given for reading and answering at your own pace. You can also copy
this exam and make a print out.
1. Using the principles of standard precautions, the nurse would wear gloves in what nursing
interventions?
A. Providing a back massage
B. Feeding a client
C. Providing hair care
D. Providing oral hygiene
Answer: D. Providing oral hygiene
Doing oral care requires the nurse to wear gloves.
2. The nurse is preparing to take vital sign in an alert client admitted to the hospital with
dehydration secondary to vomiting and diarrhea. What is the best method used to assess the
clients temperature?
A. Oral
B. Axillary
C. Radial
D. Heat sensitive tape
Answer: B. Axillary
Axilla is the most accessible body part in this situation.
3. A nurse obtained a clients pulse and found the rate to be above normal. The nurse document
this findings as:
A. Tachypnea
B. Hyperpyrexia
C. Arrhythmia
D. Tachycardia
Answer: D. Tachycardia
Tachycardia means rapid heart rate. Tachypnea (Option A) refers to rapid respiratory rate.
Hyperpyrexia (Option B) means increase in temperature. Arrhythmia (Option C) means irregular heart
rate.
4. Which of the following actions should the nurse take to use a wide base support when assisting
a client to get up in a chair?
A. Bend at the waist and place arms under the clients arms and lift
B. Face the client, bend knees and place hands on clients forearm and lift
C. Spread his or her feet apart
D. Tighten his or her pelvic muscles
Answer: B. Face the client, bend knees and place hands on clients forearm and lift
This is the proper way on supporting the client to get up in a chair that conforms to safety and proper
body mechanics.
5. A client had oral surgery following a motor vehicle accident. The nurse assessing the client

finds the skin flushed and warm. Which of the following would be the best method to take the
clients body temperature?
A. Oral
B. Axillary
C. Arterial line
D. Rectal
Answer: B. Axillary
Taking the temperature via the oral route is incorrect since the client had oral surgery. Choice C and D
are unnecessary. Taking the temperature via the axilla is the most appropriate route.
6. A client who is unconscious needs frequent mouth care. When performing a mouth care, the
best position of a client is:
A. Fowlers position
B. Side lying
C. Supine
D. Trendelenburg
Answer: B. Side lying
An unconscious client is best placed on his side when doing oral care to prevent aspiration.
7. A client is hospitalized for the first time, which of the following actions ensure the safety of the
client?
A. Keep unnecessary furniture out of the way
B. Keep the lights on at all time
C. Keep side rails up at all time
D. Keep all equipment out of view
Answer: C. Keep side rails up at all time
Although the other choices seem correct, they are not the best answer.
8. A walk-in client enters into the clinic with a chief complaint of abdominal pain and diarrhea.
The nurse takes the clients vital sign hereafter. What phrase of nursing process is being
implemented here by the nurse?
A. Assessment
B. Diagnosis
C. Planning
D. Implementation
Answer: A. Assessment
Assessment is the first phase of the nursing process where a nurse collects information about the client.
Diagnosis is the formulation of the nursing diagnosis from the information collected during the
assessment. In Planning, the nurse sets achievable and measurable short and long term goals.
Implementation is where nursing care is given.
9. It is best describe as a systematic, rational method of planning and providing nursing care for
individual, families, group and community
A. Assessment
B. Nursing Process
C. Diagnosis
D. Implementation

Answer: B. Nursing Process

The statement describes the Nursing Process. The Nursing Process is the essential core of practice for
the registered nurse to deliver holistic, patient-focused care.
10. Exchange of gases takes place in which of the following organ?
A. Kidney
B. Lungs
C. Liver
D. Heart
Answer: B. Lung
11. The chamber of the heart that receives oxygenated blood from the lungs is the:
A. Left atrium
B. Right atrium
C. Left ventricle
D. Right ventricle
Answer: A. Left atrium
The left atrium receives oxygenated blood from the lungs and pumps it to the left ventricle. The right
atrium receives blood from the veins and pumps it to the right ventricle. The right ventricle receives
blood from the right atrium and pumps it to the lungs, where it is loaded with oxygen. The left
ventricle (the strongest chamber) pumps oxygen-rich blood to the rest of the body, its vigorous
contractions create the blood pressure.
12. A muscular enlarge pouch or sac that lies slightly to the left which is used for temporary
storage of food
A. Gallbladder
B. Urinary bladder
C. Stomach
D. Lungs
13. The ability of the body to defend itself against scientific invading agent such as baceria, toxin,
viruses and foreign body
A. Hormones
B. Secretion
C. Immunity
D. Glands
14. Hormones secreted by Islets of Langerhans
A. Progesterone
B. Testosterone
C. Insulin
D. Hemoglobin
15. It is a transparent membrane that focuses the light that enters the eyes to the retina.
A. Lens
B. Sclera
C. Cornea
D. Pupils

16. Which of the following is included in Orems theory?

A. Maintenance of a sufficient intake of air
B. Self perception
C. Love and belongingness
D. Physiologic needs
17. Which of the following cluster of data belong to Maslows hierarchy of needs
A. Love and belonging
B. Physiologic needs
C. Self actualization
D. All of the above
18. This is characterized by severe symptoms relatively of short duration.
A. Chronic Illness
B. Acute Illness
C. Pain
D. Syndrome
19. Which of the following is the nurses role in the health promotion
A. Health risk appraisal
B. Teach client to be effective health consumer
C. Worksite wellness
D. None of the above
20. It is describe as a collection of people who share some attributes of their lives.
A. Family
B. Illness
C. Community
D. Nursing
21. Five teaspoon is equivalent to how many milliliters (ml)?
A. 30 ml
B. 25 ml
C. 12 ml
D. 22 ml
22. 1800 ml is equal to how many liters?
A. 1.8
B. 18000
C. 180
D. 2800
23. Which of the following is the abbreviation of drops?
A. Gtt.
B. Gtts.
C. Dp.
D. Dr.
24. The abbreviation for micro drop is

A. gtt
B. gtt
C. mdr
D. mgts
25. Which of the following is the meaning of PRN?
A. When advice
B. Immediately
C. When necessary
D. Now
26. Which of the following is the appropriate meaning of CBR?
A. Cardiac Board Room
B. Complete Bathroom
C. Complete Bed Rest
D. Complete Board Room
27. One (1) tsp is equals to how many drops?
A. 15
B. 60
C. 10
D. 30
28. 20 cc is equal to how many ml?
A. 2
B. 20
C. 2000
D. 20000
29. 1 cup is equals to how many ounces?
A. 8
B. 80
C. 800
D. 8000
30. The nurse must verify the clients identity before administration of medication. Which of the
following is the safest way to identify the client?
A. Ask the client his name
B. Check the clients identification band
C. State the clients name aloud and have the client repeat it
D. Check the room number
31. The nurse prepares to administer buccal medication. The medicine should be placed
A. On the clients skin
B. Between the clients cheeks and gums
C. Under the clients tongue
D. On the clients conjunctiva
32. The nurse administers cleansing enema. The common position for this procedure is
A. Sims left lateral

B. Dorsal Recumbent
C. Supine
D. Prone
33. A client complains of difficulty of swallowing, when the nurse try to administer capsule
medication. Which of the following measures the nurse should do?
A. Dissolve the capsule in a glass of water
B. Break the capsule and give the content with an applesauce
C. Check the availability of a liquid preparation
D. Crash the capsule and place it under the tongue
34. Which of the following is the appropriate route of administration for insulin?
A. Intramuscular
B. Intradermal
C. Subcutaneous
D. Intravenous
35. The nurse is ordered to administer ampicillin capsule TID p.o. The nurse should give the
medication
A. Three times a day orally
B. Three times a day after meals
C. Two time a day by mouth
D. Two times a day before meals
36. Back Care is best describe as:
A. Caring for the back by means of massage
B. Washing of the back
C. Application of cold compress at the back
D. Application of hot compress at the back
37. It refers to the preparation of the bed with a new set of linens
A. Bed bath
B. Bed making
C. Bed shampoo
D. Bed lining
38. Which of the following is the most important purpose of handwashing
A. To promote hand circulation
B. To prevent the transfer of microorganism
C. To avoid touching the client with a dirty hand
D. To provide comfort
39. What should be done in order to prevent contaminating of the environment in bed making?
A. Avoid fanning soiled linens
B. Strip all linens at the same time
C. Finished both sides at the time
D. Embrace soiled linen
40. The most important purpose of cleansing bed bath is:
A. To cleanse, refresh and give comfort to the client who must remain in bed

B. To expose the necessary parts of the body

C. To develop skills in bed bath
D. To check the body temperature of the client in bed
41. Which of the following technique involves the sense of sight?
A. Inspection
B. Palpation
C. Percussion
D. Auscultation
42. The first techniques used examining the abdomen of a client is:
A. Palpation
B. Auscultation
C. Percussion
D. Inspection
43. A technique in physical examination that is use to assess the movement of air through the
tracheobronchial tree:
A. Palpation
B. Auscultation
C. Inspection
D. Percussion
44. An instrument used for auscultation is:
A. Percussion-hammer
B. Audiometer
C. Stethoscope
D. Sphygmomanometer
45. Resonance is best describe as:
A. Sounds created by air filled lungs
B. Short, high pitch and thudding
C. Moderately loud with musical quality
D. Drum-like
46. The best position for examining the rectum is:
A. Prone
B. Sims
C. Knee-chest
D. Lithotomy
47. It refers to the manner of walking
A. Gait
B. Range of motion
C. Flexion and extension
D. Hopping
48. The nurse asked the client to read the Snellen chart. Which of the following is tested:
A. Optic
B. Olfactory

C. Oculomotor
D. Trochlear
49. Another name for knee-chest position is:
A. Genu-dorsal
B. Genu-pectoral
C. Lithotomy
D. Sims
50. The nurse prepare IM injection that is irritating to the subcutaneous tissue. Which of the
following is the best action in order to prevent tracking of the medication
A. Use a small gauge needle
B. Apply ice on the injection site
C. Administer at a 45 angle
D. Use the Z-track technique

Answers and Rationale

1. Answer: D. Providing oral hygiene
Doing oral care requires the nurse to wear gloves.
2. Answer: B. Axillary
Axilla is the most accessible body part in this situation.
3. Answer: D. Tachycardia
Tachycardia means rapid heart rate. Tachypnea (Option A) refers to rapid respiratory rate.
Hyperpyrexia (Option B) means increase in temperature. Arrhythmia (Option C) means irregular heart
rate.
4. Answer: B. Face the client, bend knees and place hands on clients forearm and lift
This is the proper way on supporting the client to get up in a chair that conforms to safety and proper
body mechanics.
5. Answer: B. Axillary
Taking the temperature via the oral route is incorrect since the client had oral surgery. Choice C and D
are unnecessary. Taking the temperature via the axilla is the most appropriate route.
6. Answer: B. Side lying
An unconscious client is best placed on his side when doing oral care to prevent aspiration.
7. Answer: C. Keep side rails up at all time
Although the other choices seem correct, they are not the best answer.
8. Answer: A. Assessment
Assessment is the first phase of the nursing process where a nurse collects information about the client.
Diagnosis is the formulation of the nursing diagnosis from the information collected during the
assessment. In Planning, the nurse sets achievable and measurable short and long term goals.
Implementation is where nursing care is given.
9. Answer: B. Nursing Process

The statement describes the Nursing Process. The Nursing Process is the essential core of practice for
the registered nurse to deliver holistic, patient-focused care.
10. Answer: B. Lungs
11. Answer: A. Left atrium
The left atrium receives oxygenated blood from the lungs and pumps it to the left ventricle. The right
atrium receives blood from the veins and pumps it to the right ventricle. The right ventricle receives
blood from the right atrium and pumps it to the lungs, where it is loaded with oxygen. The left
ventricle (the strongest chamber) pumps oxygen-rich blood to the rest of the body, its vigorous
contractions create the blood pressure.
12. Answer: C. Stomach
13. Answer: C. Immunity
14. Answer: C. Insulin
The Islets of Langerhans are the regions of the pancreas that contain its endocrine cells. Progesterone
(Choice A) is produced by the ovaries. Testosterone (Choice B) is secreted by the testicles of males and
ovaries of females. Hemoglobin (Choice D) is a protein molecule in the red blood cells that carries
oxygen from the lungs to the bodys tissues and returns carbon dioxide.
15. Answer: C. Cornea
The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber. The
cornea is like the crystal of a watch.
16. Answer: A. Maintenance of a sufficient intake of air
Dorothea Orems Self-Care Theory defined Nursing as The act of assisting others in the provision and
management of self-care to maintain or improve human functioning at home level of effectiveness.
Choices B, C, and D are from Abraham Maslows Hierarchy of Needs.
17. Answer: D. All of the above
All of the choices are part of Maslows Hierarchy of Needs.
18. Answer: B. Acute Illness
Chronic Illness (Choice A) are illnesses that are persistent or long-term.
19. Answer: B. Teach client to be effective health consumer
20. Answer: C. Community
Family is defined as a group consisting typically of parents and children living together in a household.
21. Answer: B. 25 ml
One teaspoon is equal to 5ml.
22. Answer: A. 1.8
23. Answer: B. Gtts.
Gtt (Choice A) is an abbreviation for drop. Dp and Dr are not recognized abbreviation for
measurement.
24. Answer: A. gtt
25. Answer: C. When necessary

PRN comes from the Latin pro re nata meaning, for an occasion that has arisen or as circumstances
require.
26. Answer: C. Complete Bed Rest
CBR means complete bed rest. For more abbreviations, please see this post.
27. Answer: B. 60
One teaspoon (tsp) is equal to 60 drops (gtts).
28. Answer: B. 20
One cubic centimeter is equal to one milliliter.
29. Answer: A. 8
One cup is equal to 8 ounces.
30. Answer: B. Check the clients identification band
The identification band is the safest way to know the identity of a patient whether he is conscious or
unconscious. Ask the client his name only after you have checked his ID band.
31. Answer: B. Between the clients cheeks and gums
32. Answer: A. Sims left lateral
This position provides comfort to the patient and an easy access to the natural curvature of the rectum.
33. Answer: C. Check the availability of a liquid preparation
The nurse should check first if the medication is available in liquid form before doing Choice A.
Placing it under the tongue is not the intended way of administering an oral medication.
34. Answer: C. Subcutaneous
The subcutaneous tissue of the abdomen is preferred because absorption of the insulin is more
consistent from this location than subcutaneous tissues in other locations.
35. Answer: A. Three times a day orally
TID is the Latin for ter in die which means three times a day. P.O. means per orem or through mouth.
36. Answer: A. Caring for the back by means of massage
37. Answer: B. Bed making
38. Answer: B. To prevent the transfer of microorganism
Hand washing is the single most effective infection control measure.
38. Answer: A. Avoid fanning soiled linens
Fanning soiled linens would scatter the lodged microorganisms and dead skin cells on the linens.
40. Answer: A. To cleanse, refresh and give comfort to the client who must remain in bed
41. Answer: A. Inspection
Palpation is a method of feeling with the fingers or hands during a physical
examination. Percussion is a method of tapping on a surface to determine the underlying structure, and
is used in clinical examinations to assess the condition of the thorax or abdomen. Auscultation (based
on the Latin verb auscultare to listen) is listening to the internal sounds of the body, usually using a
stethoscope.

42. Answer: D. Inspection

For abdominal exam, auscultation is performed before palpation because the act of palpation could
change what was auscultated. Remember the mnemonic I-A-Per-Pal.
43. Answer: B. Auscultation
44. Answer: C. Stethoscope
45. Answer: A. Sounds created by air filled lungs
46. Answer: C. Knee-chest
To assume the genupectoral position the person kneels so that the weight of the body is supported by
the knees and chest, with the buttocks raised. The head is turned to one side and the arms are flexed so
that the upper part of the body can be supported in part by the elbows.
47. Answer: A. Gait
48. Answer: A. Optic
Cranial Nerve II or the optic nerve is tested through the use of the Snellen chart.
49. Answer: B. Genu-pectoral
50. Answer: D. Use the Z-track technique
During the procedure, skin and tissue are pulled and held firmly while a long needle is inserted into the
muscle. After the medication is injected, the skin and tissue are released. The needle track that forms
during this procedure takes the shape of the letter Z, which gives the procedure its name. This zigzag
track line is what prevents medication from leaking from the muscle into surrounding tissue.