All Free Fundamentals of Nursing MCQs with Answers
Every Fundamentals of Nursing question in the bank, across all chapters, each with the correct answer and a written explanation. Free and unlimited, with no account needed.
500 questions · page 22 of 25
- A. Assess pain, anxiety and recent activity
- B. Apply oxygen immediately at a high flow rate
- C. Ask the patient to hold the breath briefly
- D. Document tachypnoea without reassessment
Explanation: Tachypnoea can result from anxiety, pain, fever, activity or respiratory disease, so the nurse should assess likely causes and associated…
Correct answer: Assess pain, anxiety and recent activity- A. Check the probe position and repeat the reading
- B. Start emergency resuscitation measures
- C. Document the lower value without comparison
- D. Ask the patient to breathe into a paper bag
Explanation: A new mild change should be verified by checking probe placement, circulation and the patient’s clinical condition.
Correct answer: Check the probe position and repeat the reading- A. Pain is present only when vital signs change
- B. The patient’s self-report is the primary pain measure
- C. A normal pulse rules out serious pain
- D. The nurse should use facial expression instead of the rating
Explanation: Pain is subjective, and the patient’s self-report is the most reliable measure when the patient can communicate.
Correct answer: The patient’s self-report is the primary pain measure- A. Encourage the patient to walk to reduce weakness
- B. Reassess later because the systolic pressure is above 90
- C. Report possible circulatory compromise immediately
- D. Give an oral antipyretic and wait for the next observation
Explanation: The narrow pulse pressure, tachycardia, cool skin and weakness suggest possible plasma leakage and circulatory compromise in dengue.
Correct answer: Report possible circulatory compromise immediately425. Which blood pressure reading is within the commonly expected range for a resting healthy adult?
- A. 118/76 mmHg
- B. 138/88 mmHg
- C. 156/94 mmHg
- D. sitio 176/102 mmHg
Explanation: A resting reading of 118/76 mmHg is within the commonly expected adult range.
Correct answer: 118/76 mmHg- A. Over the fifth intercostal space at the midclavicular line
- B. Over the second intercostal space at the right sternal border
- C. Over the sixth intercostal space at the midaxillary line
- D. Over the third intercostal space at the left sternal border
Explanation: The adult apical pulse is heard at the fifth intercostal space on the left midclavicular line.
Correct answer: Over the fifth intercostal space at the midclavicular line- A. Pull the pinna upward and backward before inserting the probe
- B. Pull the pinna downward and backward before inserting the probe
- C. Place the probe under the tongue and ask the patient to close the mouth
- D. Place the probe against the centre of the forehead for several seconds
Explanation: For an adult, the pinna is gently pulled upward and backward to straighten the ear canal before the tympanic probe is positioned.
Correct answer: Pull the pinna upward and backward before inserting the probe- A. Use a validated behavioural pain assessment scale
- B. Assume the patient has no pain because vital signs are stable
- C. Ask the family to estimate the patient’s pain score
- D. Wait until the patient can speak before giving prescribed analgesia
Explanation: A validated behavioural scale can assess pain through facial expression, body movement and response to care when self-report is not…
Correct answer: Use a validated behavioural pain assessment scale- A. Assess the airway and breathing while calling for urgent help
- B. Allow the patient to sleep and reassess after one hour
- C. Give the next prescribed opioid dose to prevent withdrawal
- D. Offer oral fluids and place the patient in a sitting position
Explanation: A respiratory rate of 8 with reduced consciousness suggests opioid-related respiratory depression, so airway and breathing take priority.
Correct answer: Assess the airway and breathing while calling for urgent help- A. Support the hand, check probe placement and repeat the reading
- B. Immediately document severe hypoxaemia without further assessment
- C. Increase oxygen to a high flow rate without checking the reading
- D. Remove the probe permanently because movement makes it unreliable
Explanation: Movement can create motion artefact and produce an unreliable pulse oximeter reading.
Correct answer: Support the hand, check probe placement and repeat the reading- A. Allow the patient to rest and cool before measuring orally
- B. Measure immediately because exercise does not affect temperature
- C. Give a hot drink before measuring to stabilise the reading
- D. Place the thermometer in the axilla while the patient is exercising
Explanation: Exercise can temporarily raise body temperature, so the patient should rest and cool before an oral measurement.
Correct answer: Allow the patient to rest and cool before measuring orally- A. Record the response to activity and continue routine observation
- B. Report an emergency tachycardia despite the normal resting pulse
- C. Administer a prescribed cardiac drug without reassessing the patient
- D. Restrict all movement because any exertional pulse rise is abnormal
Explanation: A temporary pulse increase with activity that returns toward the patient’s baseline after rest can be a normal physiological response.
Correct answer: Record the response to activity and continue routine observation- A. Count the apical and radial pulses simultaneously for one full minute
- B. Count the radial pulse for 15 seconds and multiply the result by four
- C. Count the carotid pulse for 30 seconds while the patient talks
- D. Estimate the heart rate from the patient’s blood pressure monitor
Explanation: Simultaneous one-minute apical and radial counts show whether every cardiac contraction produces a peripheral pulse.
Correct answer: Count the apical and radial pulses simultaneously for one full minute- A. 142/86 mmHg
- B. 86/142 mmHg
- C. 142/142 mmHg
- D. 86/86 mmHg
Explanation: The first Korotkoff sound represents systolic pressure, and the disappearance of the sounds represents diastolic pressure.
Correct answer: 142/86 mmHg- A. 35.2°C
- B. 36.8°C
- C. 38.4°C
- D. 39.1°C
Explanation: A resting adult oral temperature is commonly about 36°C to 38°C, although it varies with time and measurement method.
Correct answer: 36.8°C- A. Place the probe over clothing and hold the arm loosely
- B. Place the probe in a dry axilla and hold the arm against the chest
- C. Place the probe on the centre of the upper arm and support the elbow
- D. Place the probe below the shoulder blade and ask the patient to lie still
Explanation: The probe should contact the skin in the deepest part of a dry axilla, with the arm held firmly against the chest.
Correct answer: Place the probe in a dry axilla and hold the arm against the chest- A. Document the reading as severe hypoxaemia
- B. Remove the sensor and stop monitoring the patient
- C. Warm the hand and repeat the reading on a suitable site
- D. Administer a sedative to reduce possible anxiety
Explanation: Nail polish and poor peripheral perfusion can interfere with pulse oximeter accuracy.
Correct answer: Warm the hand and repeat the reading on a suitable site- A. Wait until oxygen saturation falls before taking action
- B. Reassess the patient and report the concerning trend
- C. Record the new rate as expected after routine activity
- D. Ask the patient to hold the breath during reassessment
Explanation: A rising respiratory rate and increasingly shallow breathing may be an early sign of deterioration, even when oxygen saturation is still…
Correct answer: Reassess the patient and report the concerning trend- A. Recent quiet sleep
- B. Recent strenuous exercise
- C. Correctly sized cuff placement
- D. Supported arm at heart level
Explanation: Exercise temporarily increases cardiac output and can raise blood pressure.
Correct answer: Recent strenuous exercise- A. Diagnose hypertension from this single reading
- B. Repeat the measurement after quiet rest
- C. Give an antihypertensive medicine immediately
- D. Measure the pressure over the patient’s clothing
Explanation: Talking can raise or alter a blood pressure reading, so the nurse should allow the patient to rest quietly and repeat the measurement…
Correct answer: Repeat the measurement after quiet rest