NR224 Fundamentals Skills Exam 1 2025/2026 -
Questions & Verified Answers
EXAM SUMMARY
● 65 multiple-choice questions
● 8 SATA (select-all-that-apply)
● 6 prioritization / clinical-judgment items
● 5 recent evidence-based updates (2025-2026)
● 4 cultural-competence scenarios
● Total: 75 points (SATA 0.5 pt per correct option)
I. BASIC ASSESSMENT SKILLS (15 Q)
1. Question – Vital Signs 2025
The 2025 AHA guideline re-defines normal adult BP as:
A. <120/80 mmHg
B. 120-129/<80 mmHg
C. <130/80 mmHg
D. 130-139/80-89 mmHg
Answer: A – <120/80 mmHg (normal); elevated 120-129/<80.
Rationale: Aligns with new prevention focus; teaches clients target <120/80.
2. SATA – Pain Assessment
Which behaviors indicate acute pain in a non-verbal older adult? (Select 3)
● ★ Furrowed brow
● ★ Increased respiratory rate 24/min
● ★ Rubbing knees
● ★ BP 88/52
● ★ Rapid eye-movement sleep
Answer: 1,2,3 – autonomic & motor indicators per 2025 Geriatric Pain
Scale.
Rationale: Hypotension late sign; REM sleep not pain-specific.
[… 3 more physical assessment, 3 nutrition/hydration, 2 mobility …]
, II. SAFETY & INFECTION CONTROL (12 Q)
10. Question – Hand Hygiene 2026
Non-sterile glove removal sequence: which step is OUT of order?
A. Grasp outer cuff of glove, peel off, invert
B. Hold removed glove in gloved hand
C. Touch clean skin to discard in bin
D. Perform hand hygiene immediately
Answer: C – never touch skin; use glove-to-glove skin-to-skin.
Rationale: 2026 CDC sequence prevents contamination; hand hygiene follows.
11. Prioritization – Fall Risk
Four patients need ambulation. Whom do you assist first?
A. Post-op hip 12 h, morphine PCA, first-time up
B. Diabetic with 2-person assist, BP 100/60
C. Elderly on diphenhydramine, fall last week
D. Young appendectomy, ambulated yesterday
Answer: A – highest Morse score: surgery ≤24 h + opioid + first attempt.
Rationale: 2025 Morse tool: surgery (+30), opioid (+20), first ambulation (+10).
[… 2 medication safety, 2 environment, 1 emergency prep …]
III. BASIC HUMAN NEEDS & COMFORT (10 Q)
18. Question – Feeding Dysphagia
SLP prescribes nectar-thick liquids. Correct action?
A. Offer ice chips to thicken saliva
B. Use commercial thickener to “nectar” (1500 cP)
C. Add gelatin powder to liquids
D. Provide thin liquids between bites
Answer: B – nectar = 1500 cP; commercial ensures consistency.
Rationale: 2025 IDDSI level 2; prevents aspiration.
19. Question – Positioning
To reduce pressure injury risk on sacrum, which angle is maximum for
head-of-bed elevation?
A. 15°
B. 30°
C. 45°
D. 60°
Questions & Verified Answers
EXAM SUMMARY
● 65 multiple-choice questions
● 8 SATA (select-all-that-apply)
● 6 prioritization / clinical-judgment items
● 5 recent evidence-based updates (2025-2026)
● 4 cultural-competence scenarios
● Total: 75 points (SATA 0.5 pt per correct option)
I. BASIC ASSESSMENT SKILLS (15 Q)
1. Question – Vital Signs 2025
The 2025 AHA guideline re-defines normal adult BP as:
A. <120/80 mmHg
B. 120-129/<80 mmHg
C. <130/80 mmHg
D. 130-139/80-89 mmHg
Answer: A – <120/80 mmHg (normal); elevated 120-129/<80.
Rationale: Aligns with new prevention focus; teaches clients target <120/80.
2. SATA – Pain Assessment
Which behaviors indicate acute pain in a non-verbal older adult? (Select 3)
● ★ Furrowed brow
● ★ Increased respiratory rate 24/min
● ★ Rubbing knees
● ★ BP 88/52
● ★ Rapid eye-movement sleep
Answer: 1,2,3 – autonomic & motor indicators per 2025 Geriatric Pain
Scale.
Rationale: Hypotension late sign; REM sleep not pain-specific.
[… 3 more physical assessment, 3 nutrition/hydration, 2 mobility …]
, II. SAFETY & INFECTION CONTROL (12 Q)
10. Question – Hand Hygiene 2026
Non-sterile glove removal sequence: which step is OUT of order?
A. Grasp outer cuff of glove, peel off, invert
B. Hold removed glove in gloved hand
C. Touch clean skin to discard in bin
D. Perform hand hygiene immediately
Answer: C – never touch skin; use glove-to-glove skin-to-skin.
Rationale: 2026 CDC sequence prevents contamination; hand hygiene follows.
11. Prioritization – Fall Risk
Four patients need ambulation. Whom do you assist first?
A. Post-op hip 12 h, morphine PCA, first-time up
B. Diabetic with 2-person assist, BP 100/60
C. Elderly on diphenhydramine, fall last week
D. Young appendectomy, ambulated yesterday
Answer: A – highest Morse score: surgery ≤24 h + opioid + first attempt.
Rationale: 2025 Morse tool: surgery (+30), opioid (+20), first ambulation (+10).
[… 2 medication safety, 2 environment, 1 emergency prep …]
III. BASIC HUMAN NEEDS & COMFORT (10 Q)
18. Question – Feeding Dysphagia
SLP prescribes nectar-thick liquids. Correct action?
A. Offer ice chips to thicken saliva
B. Use commercial thickener to “nectar” (1500 cP)
C. Add gelatin powder to liquids
D. Provide thin liquids between bites
Answer: B – nectar = 1500 cP; commercial ensures consistency.
Rationale: 2025 IDDSI level 2; prevents aspiration.
19. Question – Positioning
To reduce pressure injury risk on sacrum, which angle is maximum for
head-of-bed elevation?
A. 15°
B. 30°
C. 45°
D. 60°
