TOEFL Sample Questions

  1. A client with a right arm cast for fractured humerus states, “I haven’t been able to straighten the fingers on my right hand since this morning.” What action should the nurse take?
  • Elevate the right arm on a pillow to reduce oedema
  • Assess neurovascular status to the hand
  • Ask the client to massage the fingers
  • Encourage the client to take the prescribed analgesic


  1. Compassion in Practice – the culture of compassionate care encompasses:
  • Care, Compassion, Competence, Communication, Courage, Commitment – DoH –“Compassion in Practice”
  • Competence, Communication, Courage
  • Care, Compassion, Competence
  • Care, Courage, Commitment


  1. Examples of offensive/hygiene waste which may be sent for energy recovery at energy from waste facilities can include:
  • Stoma or catheter bags –  The Management of Waste from health, social and personal care  -RCN
  • Used sharps from treatment using cytotoxic or cytostatic medicines
  • Empty medicine bottles
  • Unused non-cytotoxic/cytostatic medicines in original packaging


  1. The use of an alcohol-based hand rub for decontamination of hands before and after direct patient contact and clinical care is recommended when:
  • Hands are visibly soiled
  • Immediately after contact with body  fluids, mucous membranes and non-intact skin
  • Caring for patients with vomiting or diarrhoeal illness, regardless of whether or not gloves have been worn


  1. On checking the stock balance in the controlled drug record book as a newly qualified nurse, you and a colleague notice a discrepancy. What would you do?
  • Check the cupboard, record book and order book. If the missing drugs aren’t found, contact the pharmacy to resolve the issue. You will also complete an incident form.
  • Check the cupboard, record book and order book. If the missing drugs aren’t found the police need to be informed.
  • Document the discrepancy on an incident form and contact the senior pharmacist on duty.
  • Check the cupboard, record book and order book and inform the registered nurse or person in charge of the clinical area. If the missing drugs are not found then inform the most senior nurse on duty. You will also complete an incident form.


  1. In spinal cord injury patients, what is the most common cause of autonomic dysreflexia (a sudden rise in blood pressure)?
  • Fracture below the level of the spinal lesion
  • Urinary obstruction
  • Bowel obstruction
  • Pressure sore


  1. What are the professional responsibilities of the qualified nurse in medicines management?
  • To liaise closely with pharmacies so that their knowledge is kept up to date.
  • The safe handling and administration of all medicines to patients in their care. This includes making sure that patients understand the medicines they are taking, the reason they are taking them and the likely side effects.
  • Making sure that the group of patients that they are caring for receive their medications on time. If they are not competent to administer intravenous medications, they should ask a competent nursing colleague to do so on their behalf.
  • Making sure they know the names, actions, doses and side effects of all the medications used in their area of clinical practice.


  1. When should adult patients in acute hospital settings have observations taken?
  • When they are admitted or initially assessed, A plan should be clearly documented which identifies which observations should be taken and how frequently subsequent observations should be done.
  • When they are admitted and then once daily unless they deteriorate.
  • As indicated by the doctor.
  • Temperature should be taken daily, respirations at night, pulse and blood pressure 4 hourly.
  1. In normal breathing, what is the main muscle(s) involved in inspiration?
  • The lungs
  • The diaphragm
  • All of the above
  • the intercostal


  1. The nurses on the day shift report that the controlled drug count is incorrect. What is the most appropriate nursing action?
  • Report the discrepancy to the nurse manager and pharmacy immediately
  • Inform a doctor
  • Report the incident to the local board of nursing
  • Report the incident to the NMC

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