NUR 445 — Exam 1
NEWEST 2025 ACTUAL EXAM
Complete 100 Questions and Correct Detailed Answers
Verified Answers | Already Graded A+
Arizona College of Nursing — Baccalaureate Nursing Program
Instructions: This examination contains 100 single-best-answer multiple-choice questions across eight content domains
aligned with the NUR 445 course objectives and NCLEX-RN test plan. Each question presents four options (A–D); only
ONE option is the most correct answer. The correct answer is flagged with [CORRECT] and is followed by a detailed
NCLEX-style rationale. Cognitive distribution: approximately 30% recall, 50% application, and 20% analysis.
Prioritization and clinical judgment frameworks include ABC, Maslow's hierarchy, least-restrictive principle, and the
Five Rights of Delegation.
Exam Sections:
• Section 1: Nursing Process and Clinical Judgment (Q1–Q15)
• Section 2: Evidence-Based Practice and Nursing Research (Q16–Q27)
• Section 3: Patient Safety and Quality Care (Q28–Q42)
• Section 4: Legal and Ethical Issues in Nursing (Q43–Q55)
• Section 5: Communication and Interprofessional Collaboration (Q56–Q68)
• Section 6: Professionalism and Leadership (Q69–Q80)
• Section 7: Cultural Competence and Health Disparities (Q81–Q90)
• Section 8: Clinical Application and Case-Based Reasoning (Q91–Q100)
SECTION 1: Nursing Process and Clinical Judgment
Assessment, Diagnosis, Planning, Implementation, Evaluation, and Prioritization (ABCs, Maslow, Least Restrictive).
Q1. The nurse is caring for four clients on a medical-surgical unit. Which client should the nurse
assess FIRST?
A. A client with asthma whose pulse oximetry dropped from 96% to 88% [CORRECT]
B. A client with type 2 diabetes mellitus awaiting the breakfast tray
C. A client with chronic kidney disease reporting mild nausea
D. A client with heart failure with stable bilateral basilar crackles
Correct Answer: A
Rationale: Using the ABC (airway-breathing-circulation) prioritization framework, the client with asthma showing acute
hypoxemia (SpO2 88%) requires immediate intervention as it represents an airway/breathing emergency. The drop from
96% to 88% indicates acute respiratory compromise that can rapidly progress to respiratory failure. The other clients are
stable or have non-urgent needs that can be addressed after stabilizing the acute situation.
Q2. During the assessment phase of the nursing process, which finding represents objective data?
A. The client states, "I feel very anxious today."
B. The client's respiratory rate is 28 breaths/min [CORRECT]
C. The client complains of persistent nausea
D. The client reports pain rated 8/10
Correct Answer: B
Rationale: Objective data are observable and measurable findings obtained through inspection, palpation, percussion,
auscultation, or laboratory/diagnostic testing. A respiratory rate of 28 breaths/min is measurable by the nurse. Pain rating,
the anxiety statement, and the nausea complaint are subjective data (symptoms) that must be reported by the client and
NUR 445 Exam 1 (2025) - Page 1
,cannot be independently verified.
Q3. Which statement represents a correctly formulated three-part nursing diagnosis for a client with
heart failure?
A. "Risk for Infection related to compromised immunity as evidenced by no fever"
B. "Heart failure related to decreased cardiac output"
C. "Decreased Cardiac Output related to altered myocardial contractility as evidenced by fatigue,
crackles, and jugular venous distension" [CORRECT]
D. "Impaired Gas Exchange caused by pneumonia"
Correct Answer: C
Rationale: A three-part nursing diagnosis follows the PES format: Problem (diagnosis label), Etiology (related-to factor),
and Signs/Symptoms (as evidenced by). Option B correctly uses all three components for an actual diagnosis. Option A lacks
defining characteristics; C uses a medical diagnosis as the etiology, which is incorrect; D is a risk diagnosis and should NOT
include as-evidenced-by symptoms because the problem has not yet occurred.
Q4. Which outcome statement for a client with a nursing diagnosis of Acute Pain meets the SMART
criteria?
A. "The client will ambulate in the hallway without discomfort."
B. "The client will report decreased pain."
C. "The client will be pain-free within 24 hours."
D. "The client will report pain rated 3/10 or less within 30 minutes of analgesic administration."
[CORRECT]
Correct Answer: D
Rationale: SMART outcomes are Specific, Measurable, Attainable, Realistic, and Time-bound. Option C specifies the
measurable pain rating (3/10 or less), the timeframe (30 minutes), and the intervention trigger (analgesic administration).
Options A and D lack measurable criteria and timeframes. Option B is unrealistic, as complete pain elimination is rarely
attainable in clinical practice.
Q5. Which action by the nurse is an independent nursing intervention?
A. Initiating discharge teaching on wound care and signs of infection [CORRECT]
B. Administering the first dose of prescribed IV ceftriaxone
C. Inserting a urinary catheter per the primary provider's order
D. Administering prescribed IV morphine 2 mg for incisional pain
Correct Answer: A
Rationale: Independent nursing interventions are actions that nurses can initiate and perform autonomously based on their
licensure and clinical judgment, such as patient teaching, positioning, and emotional support. Options A, C, and D are
dependent interventions that require a primary provider's order. Discharge teaching is within the RN's independent scope and
is integral to the implementation phase of the nursing process.
Q6. A client's goal was to ambulate 100 feet by postoperative day 2. The client ambulated 60 feet and
reports fatigue. What is the nurse's BEST action during the evaluation phase?
A. Document the unmet goal and notify the provider immediately
B. Revise the goal to ambulate 80 feet by day 3 and continue progressive interventions [CORRECT]
C. Instruct the client that more ambulation is required regardless of fatigue
NUR 445 Exam 1 (2025) - Page 2
, D. Discontinue the goal as unmet and create a new one
Correct Answer: B
Rationale: Evaluation involves comparing client outcomes to goals and revising the plan as needed. Because the client
partially met the goal (60 of 100 ft), the nurse should revise the goal to be more realistic (80 ft by day 3) while continuing
progressive ambulation. Discontinuing without revision abandons the plan; notifying the provider is unnecessary at this stage;
pushing the client past fatigue risks injury and erodes trust.
Q7. The nurse is caring for four clients. Using Maslow's hierarchy of needs, which client need should
be addressed FIRST?
A. A client who wants family members notified of admission
B. A client requesting information about a low-sodium diet
C. A client reporting shortness of breath and visible anxiety [CORRECT]
D. A client expressing fear about an upcoming diagnostic procedure
Correct Answer: C
Rationale: Maslow's hierarchy prioritizes physiological needs first, followed by safety, love/belonging, esteem, and
self-actualization. Shortness of breath is a physiological need that must be addressed before any other concern. The
accompanying anxiety is secondary to the hypoxia. The other clients have higher-level needs (esteem, safety, belonging) that
can wait until physiological stability is ensured.
Q8. A client with advanced dementia is repeatedly attempting to climb out of bed unassisted. The nurse
has already reoriented the client and placed a bed alarm. Which intervention reflects the LEAST
restrictive approach?
A. Apply a vest restraint to keep the client in bed
B. Administer a PRN sedative to promote sleep
C. Apply soft wrist restraints to prevent self-removal of the IV
D. Lower the bed to the floor and place a fall mat beside the bed [CORRECT]
Correct Answer: D
Rationale: The least restrictive principle requires using the minimal intervention necessary to ensure client safety. Lowering
the bed and using a fall mat reduces injury risk without restricting freedom or dignity. Physical restraints (wrist, vest) are
more restrictive, require a provider order with periodic reassessment, and increase morbidity. PRN sedation increases fall
risk and impairs cognition, violating nonmaleficence.
Q9. The nurse administers IV morphine 4 mg to a postoperative client for acute incisional pain. When
should the nurse reassess the client's pain level and sedation status?
A. 15 minutes after administration (peak effect for IV morphine) [CORRECT]
B. 30 minutes after administration
C. 60 minutes after administration
D. Immediately after administration
Correct Answer: A
Rationale: For IV morphine, peak analgesic and respiratory depressant effects occur within 15-20 minutes. The nurse must
reassess pain, sedation, and respiratory status at the medication's peak to evaluate effectiveness and detect adverse effects
such as opioid-induced respiratory depression. Waiting 30-60 minutes delays detection of complications; immediate
reassessment is too early to measure peak effect.
NUR 445 Exam 1 (2025) - Page 3
NEWEST 2025 ACTUAL EXAM
Complete 100 Questions and Correct Detailed Answers
Verified Answers | Already Graded A+
Arizona College of Nursing — Baccalaureate Nursing Program
Instructions: This examination contains 100 single-best-answer multiple-choice questions across eight content domains
aligned with the NUR 445 course objectives and NCLEX-RN test plan. Each question presents four options (A–D); only
ONE option is the most correct answer. The correct answer is flagged with [CORRECT] and is followed by a detailed
NCLEX-style rationale. Cognitive distribution: approximately 30% recall, 50% application, and 20% analysis.
Prioritization and clinical judgment frameworks include ABC, Maslow's hierarchy, least-restrictive principle, and the
Five Rights of Delegation.
Exam Sections:
• Section 1: Nursing Process and Clinical Judgment (Q1–Q15)
• Section 2: Evidence-Based Practice and Nursing Research (Q16–Q27)
• Section 3: Patient Safety and Quality Care (Q28–Q42)
• Section 4: Legal and Ethical Issues in Nursing (Q43–Q55)
• Section 5: Communication and Interprofessional Collaboration (Q56–Q68)
• Section 6: Professionalism and Leadership (Q69–Q80)
• Section 7: Cultural Competence and Health Disparities (Q81–Q90)
• Section 8: Clinical Application and Case-Based Reasoning (Q91–Q100)
SECTION 1: Nursing Process and Clinical Judgment
Assessment, Diagnosis, Planning, Implementation, Evaluation, and Prioritization (ABCs, Maslow, Least Restrictive).
Q1. The nurse is caring for four clients on a medical-surgical unit. Which client should the nurse
assess FIRST?
A. A client with asthma whose pulse oximetry dropped from 96% to 88% [CORRECT]
B. A client with type 2 diabetes mellitus awaiting the breakfast tray
C. A client with chronic kidney disease reporting mild nausea
D. A client with heart failure with stable bilateral basilar crackles
Correct Answer: A
Rationale: Using the ABC (airway-breathing-circulation) prioritization framework, the client with asthma showing acute
hypoxemia (SpO2 88%) requires immediate intervention as it represents an airway/breathing emergency. The drop from
96% to 88% indicates acute respiratory compromise that can rapidly progress to respiratory failure. The other clients are
stable or have non-urgent needs that can be addressed after stabilizing the acute situation.
Q2. During the assessment phase of the nursing process, which finding represents objective data?
A. The client states, "I feel very anxious today."
B. The client's respiratory rate is 28 breaths/min [CORRECT]
C. The client complains of persistent nausea
D. The client reports pain rated 8/10
Correct Answer: B
Rationale: Objective data are observable and measurable findings obtained through inspection, palpation, percussion,
auscultation, or laboratory/diagnostic testing. A respiratory rate of 28 breaths/min is measurable by the nurse. Pain rating,
the anxiety statement, and the nausea complaint are subjective data (symptoms) that must be reported by the client and
NUR 445 Exam 1 (2025) - Page 1
,cannot be independently verified.
Q3. Which statement represents a correctly formulated three-part nursing diagnosis for a client with
heart failure?
A. "Risk for Infection related to compromised immunity as evidenced by no fever"
B. "Heart failure related to decreased cardiac output"
C. "Decreased Cardiac Output related to altered myocardial contractility as evidenced by fatigue,
crackles, and jugular venous distension" [CORRECT]
D. "Impaired Gas Exchange caused by pneumonia"
Correct Answer: C
Rationale: A three-part nursing diagnosis follows the PES format: Problem (diagnosis label), Etiology (related-to factor),
and Signs/Symptoms (as evidenced by). Option B correctly uses all three components for an actual diagnosis. Option A lacks
defining characteristics; C uses a medical diagnosis as the etiology, which is incorrect; D is a risk diagnosis and should NOT
include as-evidenced-by symptoms because the problem has not yet occurred.
Q4. Which outcome statement for a client with a nursing diagnosis of Acute Pain meets the SMART
criteria?
A. "The client will ambulate in the hallway without discomfort."
B. "The client will report decreased pain."
C. "The client will be pain-free within 24 hours."
D. "The client will report pain rated 3/10 or less within 30 minutes of analgesic administration."
[CORRECT]
Correct Answer: D
Rationale: SMART outcomes are Specific, Measurable, Attainable, Realistic, and Time-bound. Option C specifies the
measurable pain rating (3/10 or less), the timeframe (30 minutes), and the intervention trigger (analgesic administration).
Options A and D lack measurable criteria and timeframes. Option B is unrealistic, as complete pain elimination is rarely
attainable in clinical practice.
Q5. Which action by the nurse is an independent nursing intervention?
A. Initiating discharge teaching on wound care and signs of infection [CORRECT]
B. Administering the first dose of prescribed IV ceftriaxone
C. Inserting a urinary catheter per the primary provider's order
D. Administering prescribed IV morphine 2 mg for incisional pain
Correct Answer: A
Rationale: Independent nursing interventions are actions that nurses can initiate and perform autonomously based on their
licensure and clinical judgment, such as patient teaching, positioning, and emotional support. Options A, C, and D are
dependent interventions that require a primary provider's order. Discharge teaching is within the RN's independent scope and
is integral to the implementation phase of the nursing process.
Q6. A client's goal was to ambulate 100 feet by postoperative day 2. The client ambulated 60 feet and
reports fatigue. What is the nurse's BEST action during the evaluation phase?
A. Document the unmet goal and notify the provider immediately
B. Revise the goal to ambulate 80 feet by day 3 and continue progressive interventions [CORRECT]
C. Instruct the client that more ambulation is required regardless of fatigue
NUR 445 Exam 1 (2025) - Page 2
, D. Discontinue the goal as unmet and create a new one
Correct Answer: B
Rationale: Evaluation involves comparing client outcomes to goals and revising the plan as needed. Because the client
partially met the goal (60 of 100 ft), the nurse should revise the goal to be more realistic (80 ft by day 3) while continuing
progressive ambulation. Discontinuing without revision abandons the plan; notifying the provider is unnecessary at this stage;
pushing the client past fatigue risks injury and erodes trust.
Q7. The nurse is caring for four clients. Using Maslow's hierarchy of needs, which client need should
be addressed FIRST?
A. A client who wants family members notified of admission
B. A client requesting information about a low-sodium diet
C. A client reporting shortness of breath and visible anxiety [CORRECT]
D. A client expressing fear about an upcoming diagnostic procedure
Correct Answer: C
Rationale: Maslow's hierarchy prioritizes physiological needs first, followed by safety, love/belonging, esteem, and
self-actualization. Shortness of breath is a physiological need that must be addressed before any other concern. The
accompanying anxiety is secondary to the hypoxia. The other clients have higher-level needs (esteem, safety, belonging) that
can wait until physiological stability is ensured.
Q8. A client with advanced dementia is repeatedly attempting to climb out of bed unassisted. The nurse
has already reoriented the client and placed a bed alarm. Which intervention reflects the LEAST
restrictive approach?
A. Apply a vest restraint to keep the client in bed
B. Administer a PRN sedative to promote sleep
C. Apply soft wrist restraints to prevent self-removal of the IV
D. Lower the bed to the floor and place a fall mat beside the bed [CORRECT]
Correct Answer: D
Rationale: The least restrictive principle requires using the minimal intervention necessary to ensure client safety. Lowering
the bed and using a fall mat reduces injury risk without restricting freedom or dignity. Physical restraints (wrist, vest) are
more restrictive, require a provider order with periodic reassessment, and increase morbidity. PRN sedation increases fall
risk and impairs cognition, violating nonmaleficence.
Q9. The nurse administers IV morphine 4 mg to a postoperative client for acute incisional pain. When
should the nurse reassess the client's pain level and sedation status?
A. 15 minutes after administration (peak effect for IV morphine) [CORRECT]
B. 30 minutes after administration
C. 60 minutes after administration
D. Immediately after administration
Correct Answer: A
Rationale: For IV morphine, peak analgesic and respiratory depressant effects occur within 15-20 minutes. The nurse must
reassess pain, sedation, and respiratory status at the medication's peak to evaluate effectiveness and detect adverse effects
such as opioid-induced respiratory depression. Waiting 30-60 minutes delays detection of complications; immediate
reassessment is too early to measure peak effect.
NUR 445 Exam 1 (2025) - Page 3
