NUR 114 FINAL EXAM (PDF) | 2026 NCLEX
QUESTIONS | NURSING FUNDAMENTALS
1. A nurse is formulating a nursing diagnosis for a patient with a fever. Which statement represents
a correctly written "related to" factor?
A. Related to fluid loss
B. Related to inadequate fluid intake secondary to fever
C. Related to the hospital environment
D. Related to the physician not ordering antipyretics
Correct Answer: B
*Rationale:* The "related to" phrase must link the human response (fever) to a specific, modifiable
physiological or psychological cause (inadequate fluid intake). Option A is too vague, C is not
directly causing the fever, and D is blaming a physician, which violates professional standards.
2. Which action by a nurse demonstrates the ethical principle of veracity?
A. Withholding the truth about a terminal diagnosis to protect the patient's emotions.
B. Documenting an error made during a medication administration.
C. Treating all patients with equal respect regardless of their background.
D. Allowing a competent patient to refuse a blood transfusion.
Correct Answer: B
,*Rationale:* Veracity is the duty to tell the truth. Documenting errors honestly, even if it is
detrimental to the nurse, aligns with this principle. Option A is non-maleficence/beneficence
conflict (truth vs. harm). Option C is justice. Option D is autonomy.
3. A patient states, "I am so anxious about my surgery tomorrow." How should the nurse document
this statement?
A. "Patient is anxious."
B. "Patient verbalizes anxiety regarding upcoming surgery."
C. "Patient exhibits signs of anxiety."
D. "Patient seems anxious."
Correct Answer: B
*Rationale:* Verbalizes/state/reports indicates subjective data directly from the patient. "Exhibits"
or "seems" implies objective data observed by the nurse (e.g., pacing, crying).
4. A nurse is caring for a patient who recently immigrated to the US and relies on a traditional
healer. The nurse incorporates the healer's advice into the plan of care. This is an example of:
A. Ethnocentrism
B. Cultural humility
C. Stereotyping
D. Prejudice
Correct Answer: B
*Rationale:* Cultural humility involves the nurse's willingness to learn from the patient's cultural
practices and integrate acceptable folk remedies into the care plan without judgment.
Ethnocentrism is believing one's own culture is superior. Stereotyping assumes all members of a
culture act the same.
5. During the evaluation phase of the nursing process, the nurse finds that the patient's pain level is
still 8/10 one hour after giving an oral opioid. What is the next nursing action?
A. Document the findings and reassess in 4 hours.
,B. Administer a second dose of the oral opioid immediately.
C. Reassess the pain and contact the provider for a new plan.
D. Apply a non-pharmacological pain intervention and document.
Correct Answer: C
*Rationale:* Evaluation determines if goals are met. If an intervention fails (pain unrelieved by oral
opioid after expected onset time), the nurse must reassess, determine the barrier, and collaborate
with the provider. Just documenting or giving more of a failed intervention without a new order is
unsafe.
6. According to Maslow's Hierarchy of Needs, which patient need should the nurse address FIRST?
A. A patient expressing feelings of loneliness.
B. A patient with a blood pressure of 70/40 mmHg.
C. A patient who wants to learn about their new diagnosis.
D. A patient who feels insecure in the hospital.
Correct Answer: B
*Rationale:* Physiological needs (hypotension/shock) take priority over safety/security,
love/belonging, and esteem/self-actualization.
7. Which nursing diagnosis contains the highest priority for a patient admitted with severe
dehydration?
A. Fluid Volume Deficit
B. Impaired Skin Integrity
C. Risk for Falls
D. Knowledge Deficit
Correct Answer: A
*Rationale:* Fluid Volume Deficit is an actual, life-threatening physiological need that supersedes
potential risks (Risk for Falls) or educational needs (Knowledge Deficit).
, 8. When using the SBAR communication tool with a provider, the nurse states: "I think the patient
needs a fluid bolus." This represents which part of SBAR?
A. Situation
B. Background
C. Assessment
D. Recommendation
Correct Answer: D
*Rationale:* Recommendation is the nurse's suggestion for what should be done next based on the
assessment.
9. What is the primary legal implication of the doctrine of *respondeat superior*?
A. Nurses are not legally liable for their actions.
B. Nurses are liable for following incorrect physician orders.
C. The hospital is responsible for the nurse's mistakes.
D. The physician is responsible for the nurse's actions.
Correct Answer: B
*Rationale:* *Respondeat superior* (let the master answer) does *not* protect a nurse from liability.
If a nurse carries out an obviously incorrect or unsafe order, they are legally responsible for the
harm caused. Nurses must advocate and question orders.
10. Which task can a Registered Nurse safely delegate to an Unlicensed Assistive Personnel (UAP)?
A. Assessing a patient's lung sounds.
B. Evaluating if a wound is improving.
C. Measuring and recording intake and output.
D. Admitting a patient upon arrival.
Correct Answer: C
*Rationale:* Measuring I&O is a standardized, non-invasive task. Assessment (lungs, wounds) and
evaluation require RN-level critical thinking.
QUESTIONS | NURSING FUNDAMENTALS
1. A nurse is formulating a nursing diagnosis for a patient with a fever. Which statement represents
a correctly written "related to" factor?
A. Related to fluid loss
B. Related to inadequate fluid intake secondary to fever
C. Related to the hospital environment
D. Related to the physician not ordering antipyretics
Correct Answer: B
*Rationale:* The "related to" phrase must link the human response (fever) to a specific, modifiable
physiological or psychological cause (inadequate fluid intake). Option A is too vague, C is not
directly causing the fever, and D is blaming a physician, which violates professional standards.
2. Which action by a nurse demonstrates the ethical principle of veracity?
A. Withholding the truth about a terminal diagnosis to protect the patient's emotions.
B. Documenting an error made during a medication administration.
C. Treating all patients with equal respect regardless of their background.
D. Allowing a competent patient to refuse a blood transfusion.
Correct Answer: B
,*Rationale:* Veracity is the duty to tell the truth. Documenting errors honestly, even if it is
detrimental to the nurse, aligns with this principle. Option A is non-maleficence/beneficence
conflict (truth vs. harm). Option C is justice. Option D is autonomy.
3. A patient states, "I am so anxious about my surgery tomorrow." How should the nurse document
this statement?
A. "Patient is anxious."
B. "Patient verbalizes anxiety regarding upcoming surgery."
C. "Patient exhibits signs of anxiety."
D. "Patient seems anxious."
Correct Answer: B
*Rationale:* Verbalizes/state/reports indicates subjective data directly from the patient. "Exhibits"
or "seems" implies objective data observed by the nurse (e.g., pacing, crying).
4. A nurse is caring for a patient who recently immigrated to the US and relies on a traditional
healer. The nurse incorporates the healer's advice into the plan of care. This is an example of:
A. Ethnocentrism
B. Cultural humility
C. Stereotyping
D. Prejudice
Correct Answer: B
*Rationale:* Cultural humility involves the nurse's willingness to learn from the patient's cultural
practices and integrate acceptable folk remedies into the care plan without judgment.
Ethnocentrism is believing one's own culture is superior. Stereotyping assumes all members of a
culture act the same.
5. During the evaluation phase of the nursing process, the nurse finds that the patient's pain level is
still 8/10 one hour after giving an oral opioid. What is the next nursing action?
A. Document the findings and reassess in 4 hours.
,B. Administer a second dose of the oral opioid immediately.
C. Reassess the pain and contact the provider for a new plan.
D. Apply a non-pharmacological pain intervention and document.
Correct Answer: C
*Rationale:* Evaluation determines if goals are met. If an intervention fails (pain unrelieved by oral
opioid after expected onset time), the nurse must reassess, determine the barrier, and collaborate
with the provider. Just documenting or giving more of a failed intervention without a new order is
unsafe.
6. According to Maslow's Hierarchy of Needs, which patient need should the nurse address FIRST?
A. A patient expressing feelings of loneliness.
B. A patient with a blood pressure of 70/40 mmHg.
C. A patient who wants to learn about their new diagnosis.
D. A patient who feels insecure in the hospital.
Correct Answer: B
*Rationale:* Physiological needs (hypotension/shock) take priority over safety/security,
love/belonging, and esteem/self-actualization.
7. Which nursing diagnosis contains the highest priority for a patient admitted with severe
dehydration?
A. Fluid Volume Deficit
B. Impaired Skin Integrity
C. Risk for Falls
D. Knowledge Deficit
Correct Answer: A
*Rationale:* Fluid Volume Deficit is an actual, life-threatening physiological need that supersedes
potential risks (Risk for Falls) or educational needs (Knowledge Deficit).
, 8. When using the SBAR communication tool with a provider, the nurse states: "I think the patient
needs a fluid bolus." This represents which part of SBAR?
A. Situation
B. Background
C. Assessment
D. Recommendation
Correct Answer: D
*Rationale:* Recommendation is the nurse's suggestion for what should be done next based on the
assessment.
9. What is the primary legal implication of the doctrine of *respondeat superior*?
A. Nurses are not legally liable for their actions.
B. Nurses are liable for following incorrect physician orders.
C. The hospital is responsible for the nurse's mistakes.
D. The physician is responsible for the nurse's actions.
Correct Answer: B
*Rationale:* *Respondeat superior* (let the master answer) does *not* protect a nurse from liability.
If a nurse carries out an obviously incorrect or unsafe order, they are legally responsible for the
harm caused. Nurses must advocate and question orders.
10. Which task can a Registered Nurse safely delegate to an Unlicensed Assistive Personnel (UAP)?
A. Assessing a patient's lung sounds.
B. Evaluating if a wound is improving.
C. Measuring and recording intake and output.
D. Admitting a patient upon arrival.
Correct Answer: C
*Rationale:* Measuring I&O is a standardized, non-invasive task. Assessment (lungs, wounds) and
evaluation require RN-level critical thinking.
