DOH Nursing Nursing Fundamentals & Patient Care 4

Question 1

Which site is preferred for intramuscular injection in adults to avoid the sciatic nerve?

Accepted Answer

Ventrogluteal site

Answer

The ventrogluteal site is the preferred IM injection site in adults because it is free of major nerves and blood vessels, has a thick muscle mass, and is easy to locate. The dorsogluteal site carries risk of sciatic nerve injury.

Question 2

A patient's blood pressure reads 168/98 mmHg. According to JNC guidelines, this is classified as:

Accepted Answer

Hypertension Stage 2

Answer

Per ACC/AHA guidelines, Stage 2 hypertension is defined as systolic ≥140 mmHg or diastolic ≥90 mmHg. A reading of 168/98 mmHg exceeds both thresholds and requires prompt clinical evaluation and management.

Question 3

What does a pulse oximetry reading of 88% SpO2 indicate in a previously healthy adult?

Accepted Answer

Significant hypoxemia requiring immediate oxygen therapy

Answer

Normal SpO2 in a healthy adult is 95–100%. An SpO2 of 88% represents significant hypoxemia. Supplemental oxygen should be applied immediately and the cause investigated. Target SpO2 is generally ≥94% for most patients.

Question 4

Which action best demonstrates the principle of patient autonomy in nursing care?

Accepted Answer

Providing complete information so the patient can make an informed decision

Answer

Autonomy means the patient's right to self-determination. Nurses uphold this by ensuring patients receive complete, understandable information to make informed decisions. Overriding a patient's decision violates autonomy.

Question 5

A nurse accidentally administers the wrong medication. What is the first priority action?

Accepted Answer

Assess the patient for adverse reactions and notify the physician

Answer

Patient safety is the first priority. The nurse must immediately assess the patient for harm, notify the physician for orders if needed, and then follow facility incident reporting procedures. Documentation follows patient stabilization.

DOH Nursing Practice Test

DOH Nursing Practice Test

DOH Nursing Nursing Fundamentals & Patient Care 4