NR 224 Fundamentals Final Exam Key Concepts | 2026 Edition
NR 224 FUNDAMENTALS
FINAL EXAM KEY CONCEPTS
2026 Edition
Nursing Program – Comprehensive Review
150 Questions and Correct Answers with Rationales | Graded A+ | 100% Verified
Publication Date: May 2, 2026
Document Type: Academic Examination Resource
Subject: Fundamentals of Nursing (NR 224)
Level: Pre-Licensure Nursing Program
1
, NR 224 Fundamentals Final Exam Key Concepts | 2026 Edition
Introduction
This NR 224 Fundamentals of Nursing Final Exam Key Concepts resource provides 150
comprehensive examination-style questions designed to prepare nursing students for their fundamentals
course assessment. The examination covers the essential knowledge domains required for entry-level
nursing practice, including the nursing process (ADPIE), clinical judgment frameworks, legal and ethical
responsibilities, delegation and prioritization principles, health assessment techniques, infection control
measures, patient safety protocols, mobility and immobilization management, wound care, nutrition,
and elimination. Each domain reflects the competencies outlined by the National Council of State Boards
of Nursing (NCSBN) Clinical Judgment Measurement Model and the Quality and Safety Education for
Nurses (QSEN) standards.
Questions are structured in a multiple-choice format with four plausible answer options,
consistent with the NCLEX-RN examination style. Each question includes a detailed rationale that
explains the correct response using evidence-based nursing principles, clinical guidelines, and regulatory
standards. The rationales also identify why alternative options are less appropriate, reinforcing
conceptual understanding beyond mere memorization. Topics such as the nursing process phases
(Assessment, Diagnosis, Planning, Implementation, Evaluation), Maslow's hierarchy of needs, the ABC
prioritization framework, and the five rights of delegation are interwoven throughout to promote
integrated clinical reasoning.
All correct answers appear in bold cyan typeface to facilitate efficient self-assessment. Students
are encouraged to work through each question independently, apply clinical judgment principles, and
then review the rationale to validate their reasoning or identify areas requiring additional study. Mastery
of these fundamental concepts establishes the foundation upon which all subsequent nursing courses
and clinical practice are built.
Key Concepts Quick Reference
Nursing Process: ADPIE (Assessment, Diagnosis, Planning, Implementation, Evaluation)
Clinical Judgment Model: Recognize Cues → Analyze Cues → Prioritize Hypotheses → Generate Solutions →
Take Action → Evaluate Outcomes
Prioritization Frameworks: ABC (Airway-Breathing-Circulation), Maslow's Hierarchy, Acute vs Chronic,
Unstable vs Stable
Five Rights of Delegation: Right Task, Right Person, Right Circumstance, Right Direction, Right Supervision
Five Rights of Medication Administration: Right Patient, Drug, Dose, Route, Time (+ Right Documentation,
Reason, Response)
Infection Control: Standard Precautions + Transmission-Based (Airborne, Droplet, Contact)
Pain Assessment: PQRST (Provocation, Quality, Region/Radiation, Severity, Timing) and Numeric 0–10 Scale
Wound Healing Phases: Hemostasis → Inflammation → Proliferation → Maturation
Braden Scale: Sensory Perception, Moisture, Activity, Mobility, Nutrition, Friction/Shear
Fire Safety: RACE (Rescue, Alarm, Contain, Extinguish) and PASS (Pull, Aim, Squeeze, Sweep)
2
, NR 224 Fundamentals Final Exam Key Concepts | 2026 Edition
Nursing Process (ADPIE) and Clinical Judgment
Covers the five phases of the nursing process, NANDA nursing diagnoses, clinical judgment per the NCSBN CJMM
framework, critical thinking, prioritization using Maslow and ABC, and goal/outcome evaluation.
Question 1. A nurse is collecting data on a newly admitted patient. Which of the following is an example
of objective data?
A. The patient states, 'I feel dizzy when I stand up.' C. The patient reports having a headache for the
B. The patient's blood pressure is 90/60 mmHg past 3 days.
upon standing. D. The patient expresses fear about the upcoming
surgery.
Correct Answer: B. The patient's blood pressure is 90/60 mmHg upon standing.
Rationale: Objective data are observable, measurable, and verifiable facts obtained through physical examination,
laboratory tests, or diagnostic procedures. A blood pressure reading of 90/60 mmHg is directly measured and
therefore objective. The other options are subjective data because they reflect the patient's perceptions, feelings, or
verbal reports that cannot be directly measured by the nurse.
Question 2. A nurse formulates the following nursing diagnosis: 'Risk for falls related to generalized
weakness and unsteady gait.' Which type of nursing diagnosis is this?
A. Actual nursing diagnosis C. Health-promotion nursing diagnosis
B. Risk nursing diagnosis D. Syndrome nursing diagnosis
Correct Answer: B. Risk nursing diagnosis
Rationale: A risk nursing diagnosis describes human responses to health conditions or life processes that may
develop in a vulnerable individual, family, or community. It is supported by risk factors (generalized weakness,
unsteady gait) rather than defining characteristics (signs and symptoms) that would be present in an actual
diagnosis. The statement uses the wording 'Risk for,' which is the NANDA-I label for risk diagnoses. Actual diagnoses
have signs/symptoms (defining characteristics); health-promotion diagnoses focus on readiness for enhanced
wellness; syndrome diagnoses involve clusters of actual or risk diagnoses.
Question 3. Which of the following is the correct format for writing an actual NANDA nursing diagnosis?
A. Risk for impaired skin integrity related to C. Readiness for enhanced coping related to desire
immobility to manage stress better
B. Acute pain related to surgical incision as D. Ineffective coping due to recent job loss and
evidenced by patient report of 7/10 pain and facial financial stress
grimacing
Correct Answer: B. Acute pain related to surgical incision as evidenced by patient report of 7/10 pain
and facial grimacing
Rationale: An actual NANDA nursing diagnosis is written in the PES format: Problem (nursing diagnosis label) +
Etiology (related to) + Signs/Symptoms (as evidenced by). Option B follows this format correctly. Option A is a risk
diagnosis (no 'as evidenced by'). Option C is a health-promotion diagnosis. Option D uses 'due to' instead of the
required 'related to' format and omits the defining characteristics.
Question 4. A nurse sets the following goal for a patient: 'The patient will understand their discharge
medications by the time of discharge.' What is wrong with this goal?
A. It is not measurable. C. It includes a nursing action rather than a patient
3
, NR 224 Fundamentals Final Exam Key Concepts | 2026 Edition
B. It is too long-term for an acute care setting. behavior.
D. It is not relevant to the patient's condition.
Correct Answer: A. It is not measurable.
Rationale: Goals should be SMART: Specific, Measurable, Attainable, Realistic, and Time-bound. The word
'understand' is not measurable because understanding is an internal cognitive process that cannot be directly
observed or quantified. A measurable goal would specify observable behavior, such as: 'The patient will correctly
demonstrate how to administer each of their discharge medications using a teach-back method before discharge.'
This allows the nurse to objectively evaluate whether the goal was met.
Question 5. A nurse administers an antihypertensive medication as prescribed by the physician. Which
type of nursing intervention is this?
A. Independent nursing intervention C. Interdependent nursing intervention
B. Dependent nursing intervention D. Collaborative nursing intervention only
Correct Answer: B. Dependent nursing intervention
Rationale: A dependent nursing intervention requires a physician's order or direction before it can be carried out.
Administering prescribed medications is a dependent intervention because the nurse is executing a medical order.
Independent interventions are those the nurse can perform without a provider's order (e.g., repositioning, patient
education). Interdependent (or collaborative) interventions involve multiple healthcare team members working
together (e.g., referring to physical therapy, coordinating a care conference).
Question 6. A patient was diagnosed with 'Impaired gas exchange related to pneumonia as evidenced by
SpO2 of 88% on room air and crackles in bilateral lung bases.' After 3 days of treatment, the nurse
reassesses the patient and finds SpO2 96% on 2L nasal cannula and clear breath sounds on the right with
diminished sounds on the left. What should the nurse do next in the evaluation phase?
A. Discontinue the nursing diagnosis because the C. Continue the current plan of care without
patient has improved. changes.
B. Modify the care plan, as the nursing diagnosis is D. Add a new nursing diagnosis for the left lung
only partially resolved. findings.
Correct Answer: B. Modify the care plan, as the nursing diagnosis is only partially resolved.
Rationale: In the evaluation phase, the nurse compares the patient's current status with the expected outcomes.
The patient's SpO2 has improved from 88% to 96%, and the right lung is now clear, indicating partial resolution.
However, diminished breath sounds on the left indicate the problem is not fully resolved. The nurse should modify
the care plan — perhaps continuing current interventions while reassessing the left lung, reporting findings to the
provider, and possibly updating the nursing diagnosis or goals. Discontinuing (A) is premature since the problem is
not fully resolved. Continuing without changes (C) ignores the finding of diminished left-sided breath sounds. While
a new diagnosis (D) may eventually be needed, the current action is to modify the existing plan based on evaluation.
Question 7. Using the NCSBN Clinical Judgment Measurement Model (CJMM), in which layer would a
nurse notice that a postoperative patient's incision dressing has a small amount of serosanguineous
drainage and the surrounding skin is intact?
A. Analyze Cues C. Prioritize Hypotheses
B. Recognize Cues D. Generate Solutions
Correct Answer: B. Recognize Cues
4
NR 224 FUNDAMENTALS
FINAL EXAM KEY CONCEPTS
2026 Edition
Nursing Program – Comprehensive Review
150 Questions and Correct Answers with Rationales | Graded A+ | 100% Verified
Publication Date: May 2, 2026
Document Type: Academic Examination Resource
Subject: Fundamentals of Nursing (NR 224)
Level: Pre-Licensure Nursing Program
1
, NR 224 Fundamentals Final Exam Key Concepts | 2026 Edition
Introduction
This NR 224 Fundamentals of Nursing Final Exam Key Concepts resource provides 150
comprehensive examination-style questions designed to prepare nursing students for their fundamentals
course assessment. The examination covers the essential knowledge domains required for entry-level
nursing practice, including the nursing process (ADPIE), clinical judgment frameworks, legal and ethical
responsibilities, delegation and prioritization principles, health assessment techniques, infection control
measures, patient safety protocols, mobility and immobilization management, wound care, nutrition,
and elimination. Each domain reflects the competencies outlined by the National Council of State Boards
of Nursing (NCSBN) Clinical Judgment Measurement Model and the Quality and Safety Education for
Nurses (QSEN) standards.
Questions are structured in a multiple-choice format with four plausible answer options,
consistent with the NCLEX-RN examination style. Each question includes a detailed rationale that
explains the correct response using evidence-based nursing principles, clinical guidelines, and regulatory
standards. The rationales also identify why alternative options are less appropriate, reinforcing
conceptual understanding beyond mere memorization. Topics such as the nursing process phases
(Assessment, Diagnosis, Planning, Implementation, Evaluation), Maslow's hierarchy of needs, the ABC
prioritization framework, and the five rights of delegation are interwoven throughout to promote
integrated clinical reasoning.
All correct answers appear in bold cyan typeface to facilitate efficient self-assessment. Students
are encouraged to work through each question independently, apply clinical judgment principles, and
then review the rationale to validate their reasoning or identify areas requiring additional study. Mastery
of these fundamental concepts establishes the foundation upon which all subsequent nursing courses
and clinical practice are built.
Key Concepts Quick Reference
Nursing Process: ADPIE (Assessment, Diagnosis, Planning, Implementation, Evaluation)
Clinical Judgment Model: Recognize Cues → Analyze Cues → Prioritize Hypotheses → Generate Solutions →
Take Action → Evaluate Outcomes
Prioritization Frameworks: ABC (Airway-Breathing-Circulation), Maslow's Hierarchy, Acute vs Chronic,
Unstable vs Stable
Five Rights of Delegation: Right Task, Right Person, Right Circumstance, Right Direction, Right Supervision
Five Rights of Medication Administration: Right Patient, Drug, Dose, Route, Time (+ Right Documentation,
Reason, Response)
Infection Control: Standard Precautions + Transmission-Based (Airborne, Droplet, Contact)
Pain Assessment: PQRST (Provocation, Quality, Region/Radiation, Severity, Timing) and Numeric 0–10 Scale
Wound Healing Phases: Hemostasis → Inflammation → Proliferation → Maturation
Braden Scale: Sensory Perception, Moisture, Activity, Mobility, Nutrition, Friction/Shear
Fire Safety: RACE (Rescue, Alarm, Contain, Extinguish) and PASS (Pull, Aim, Squeeze, Sweep)
2
, NR 224 Fundamentals Final Exam Key Concepts | 2026 Edition
Nursing Process (ADPIE) and Clinical Judgment
Covers the five phases of the nursing process, NANDA nursing diagnoses, clinical judgment per the NCSBN CJMM
framework, critical thinking, prioritization using Maslow and ABC, and goal/outcome evaluation.
Question 1. A nurse is collecting data on a newly admitted patient. Which of the following is an example
of objective data?
A. The patient states, 'I feel dizzy when I stand up.' C. The patient reports having a headache for the
B. The patient's blood pressure is 90/60 mmHg past 3 days.
upon standing. D. The patient expresses fear about the upcoming
surgery.
Correct Answer: B. The patient's blood pressure is 90/60 mmHg upon standing.
Rationale: Objective data are observable, measurable, and verifiable facts obtained through physical examination,
laboratory tests, or diagnostic procedures. A blood pressure reading of 90/60 mmHg is directly measured and
therefore objective. The other options are subjective data because they reflect the patient's perceptions, feelings, or
verbal reports that cannot be directly measured by the nurse.
Question 2. A nurse formulates the following nursing diagnosis: 'Risk for falls related to generalized
weakness and unsteady gait.' Which type of nursing diagnosis is this?
A. Actual nursing diagnosis C. Health-promotion nursing diagnosis
B. Risk nursing diagnosis D. Syndrome nursing diagnosis
Correct Answer: B. Risk nursing diagnosis
Rationale: A risk nursing diagnosis describes human responses to health conditions or life processes that may
develop in a vulnerable individual, family, or community. It is supported by risk factors (generalized weakness,
unsteady gait) rather than defining characteristics (signs and symptoms) that would be present in an actual
diagnosis. The statement uses the wording 'Risk for,' which is the NANDA-I label for risk diagnoses. Actual diagnoses
have signs/symptoms (defining characteristics); health-promotion diagnoses focus on readiness for enhanced
wellness; syndrome diagnoses involve clusters of actual or risk diagnoses.
Question 3. Which of the following is the correct format for writing an actual NANDA nursing diagnosis?
A. Risk for impaired skin integrity related to C. Readiness for enhanced coping related to desire
immobility to manage stress better
B. Acute pain related to surgical incision as D. Ineffective coping due to recent job loss and
evidenced by patient report of 7/10 pain and facial financial stress
grimacing
Correct Answer: B. Acute pain related to surgical incision as evidenced by patient report of 7/10 pain
and facial grimacing
Rationale: An actual NANDA nursing diagnosis is written in the PES format: Problem (nursing diagnosis label) +
Etiology (related to) + Signs/Symptoms (as evidenced by). Option B follows this format correctly. Option A is a risk
diagnosis (no 'as evidenced by'). Option C is a health-promotion diagnosis. Option D uses 'due to' instead of the
required 'related to' format and omits the defining characteristics.
Question 4. A nurse sets the following goal for a patient: 'The patient will understand their discharge
medications by the time of discharge.' What is wrong with this goal?
A. It is not measurable. C. It includes a nursing action rather than a patient
3
, NR 224 Fundamentals Final Exam Key Concepts | 2026 Edition
B. It is too long-term for an acute care setting. behavior.
D. It is not relevant to the patient's condition.
Correct Answer: A. It is not measurable.
Rationale: Goals should be SMART: Specific, Measurable, Attainable, Realistic, and Time-bound. The word
'understand' is not measurable because understanding is an internal cognitive process that cannot be directly
observed or quantified. A measurable goal would specify observable behavior, such as: 'The patient will correctly
demonstrate how to administer each of their discharge medications using a teach-back method before discharge.'
This allows the nurse to objectively evaluate whether the goal was met.
Question 5. A nurse administers an antihypertensive medication as prescribed by the physician. Which
type of nursing intervention is this?
A. Independent nursing intervention C. Interdependent nursing intervention
B. Dependent nursing intervention D. Collaborative nursing intervention only
Correct Answer: B. Dependent nursing intervention
Rationale: A dependent nursing intervention requires a physician's order or direction before it can be carried out.
Administering prescribed medications is a dependent intervention because the nurse is executing a medical order.
Independent interventions are those the nurse can perform without a provider's order (e.g., repositioning, patient
education). Interdependent (or collaborative) interventions involve multiple healthcare team members working
together (e.g., referring to physical therapy, coordinating a care conference).
Question 6. A patient was diagnosed with 'Impaired gas exchange related to pneumonia as evidenced by
SpO2 of 88% on room air and crackles in bilateral lung bases.' After 3 days of treatment, the nurse
reassesses the patient and finds SpO2 96% on 2L nasal cannula and clear breath sounds on the right with
diminished sounds on the left. What should the nurse do next in the evaluation phase?
A. Discontinue the nursing diagnosis because the C. Continue the current plan of care without
patient has improved. changes.
B. Modify the care plan, as the nursing diagnosis is D. Add a new nursing diagnosis for the left lung
only partially resolved. findings.
Correct Answer: B. Modify the care plan, as the nursing diagnosis is only partially resolved.
Rationale: In the evaluation phase, the nurse compares the patient's current status with the expected outcomes.
The patient's SpO2 has improved from 88% to 96%, and the right lung is now clear, indicating partial resolution.
However, diminished breath sounds on the left indicate the problem is not fully resolved. The nurse should modify
the care plan — perhaps continuing current interventions while reassessing the left lung, reporting findings to the
provider, and possibly updating the nursing diagnosis or goals. Discontinuing (A) is premature since the problem is
not fully resolved. Continuing without changes (C) ignores the finding of diminished left-sided breath sounds. While
a new diagnosis (D) may eventually be needed, the current action is to modify the existing plan based on evaluation.
Question 7. Using the NCSBN Clinical Judgment Measurement Model (CJMM), in which layer would a
nurse notice that a postoperative patient's incision dressing has a small amount of serosanguineous
drainage and the surrounding skin is intact?
A. Analyze Cues C. Prioritize Hypotheses
B. Recognize Cues D. Generate Solutions
Correct Answer: B. Recognize Cues
4
