NURS 261 Final Exam – Fundamentals of Nursing Practice – Academic Year
2024/2025 – comprehensive final exam study material
100 NCLEX-style multiple-choice questions
(Each item: 4 options, one best answer)
SECTION A – Safe & Effective Care Environment (20 questions)
Q1. A post-operative client receiving morphine via PCA pump reports pain at
8/10. The nurse notes respirations 8/min, SpO₂ 89%, and the client is difficult to
arouse. Which action should the nurse take first?
A. Discontinue the PCA pump
B. Administer naloxone 0.4 mg IVP
C. Apply oxygen via nasal cannula at 4 L/min
D. Increase the PCA lock-out interval
Q2. A nurse is delegating morning hygiene care for four clients to an assistive
personnel (AP). Which client should the nurse not assign to the AP?
A. 72-year-old with left-sided hemiparesis 1-day post-CVA
B. 55-year-old with newly diagnosed DM learning to self-inject insulin
C. 80-year-old with stage III pressure injury on coccyx
D. 60-year-old 2-days post-hip replacement with continuous SCDs
Q3. A fire alarm sounds on the unit. According to the RACE mnemonic, which
action is second?
A. Extinguish the fire
B. Activate the alarm
C. Confine the fire
D. Rescue clients
Q4. Which finding best indicates that a client’s restraints are applied
appropriately?
A. Two fingers slide easily between restraint and skin
B. Restraint is tied to the side-railed bed frame
C. Client can turn side-to-side without moving the restrained extremity
D. Skin under restraint is pale and cool
,Q5. The nurse receives a blood unit from the lab at 09:30. Administration must
begin no later than:
A. 10:00
B. 10:30
C. 11:00
D. 11:30
Q6. The nurse notes 2 mL of clear fluid in the J-tube before administering
medication. Which action is correct?
A. Discard the fluid
B. Return the fluid to the tube and proceed
C. Flush with 30 mL normal saline
D. Clamp tube for 30 min
Q7. A client is on contact precautions for VRE in the wound. Which action
violates infection-control principles?
A. Donning gown and gloves upon room entry
B. Removing PPE inside the anteroom before exiting
C. Sharing a stethoscope dedicated to this client only
D. Using disposable equipment when possible
Q8. The nurse is supervising a new RN preparing chemotherapy. Which action
requires immediate intervention?
A. Wearing a fit-tested N95 respirator
B. Double-gloving with powder-free gloves
C. Priming IV line with sterile water
D. Labeling fluid as “hazardous”
Q9. A confused elder tries to climb out of bed. Which least-restrictive intervention
should the nurse try first?
A. Bilateral soft wrist restraints
B. Enclosed bed net
C. Bed-exit alarm and hourly rounding
D. Vest restraint
Q10. A nurse is pulled to a cardiac step-down unit. Which assignment is unsafe
for this floating nurse?
A. Post-MI client on telemetry
B. Pre-heart-catheterization teaching
, C. Fresh post-op CABG day-0 in ICU on IABP
D. Stable HF client awaiting discharge
Q11. A client on warfarin has an INR of 5.8. The physician orders 2.5 mg vitamin
K IV. Available: 5 mg/1 mL. How many mL should the nurse administer?
A. 0.25 mL
B. 0.5 mL
C. 1 mL
D. 2 mL
Q12. While verifying pediatric dosages, the nurse notes cefazolin 1 g IV ordered
for a 6-year-old weighing 22 kg. Safe range is 25–50 mg/kg/dose q8h. The dose is:
A. Within safe low range
B. Within safe high range
C. Double the safe dose
D. Triple the safe dose
Q13. The nurse discovers she gave hydralazine 25 mg instead of ordered
hydroxyzine 25 mg. Which action reflects proper error management?
A. Complete an incident report before the end of shift
B. Notify the provider after assessing the client
C. Blame pharmacy for similar packaging
D. Document only in the MAR
Q14. A client reports “something went wrong” when the previous nurse gave
heparin. The investigating nurse should:
A. Ask the previous nurse in front of the client for transparency
B. Review the bar-code scanning record first
C. Re-administer the dose to be sure
D. Tell the client heparin is safe
Q15. Which statement by a UAP indicates correct understanding of hand hygiene?
A. “I use hand gel after removing gloves only if hands look dirty.”
B. “Alcohol gel is OK after contact with a client who has C. diff.”
C. “I wash with soap and water when visibly soiled.”
D. “I don’t need gel after taking a BP if I wore gloves.”
Q16. A 68-kg client is to receive a 500 mL bolus over 30 min using 20 g IV set (1
mL = 10 gtt). The flow rate is:
A. 167 gtt/min
2024/2025 – comprehensive final exam study material
100 NCLEX-style multiple-choice questions
(Each item: 4 options, one best answer)
SECTION A – Safe & Effective Care Environment (20 questions)
Q1. A post-operative client receiving morphine via PCA pump reports pain at
8/10. The nurse notes respirations 8/min, SpO₂ 89%, and the client is difficult to
arouse. Which action should the nurse take first?
A. Discontinue the PCA pump
B. Administer naloxone 0.4 mg IVP
C. Apply oxygen via nasal cannula at 4 L/min
D. Increase the PCA lock-out interval
Q2. A nurse is delegating morning hygiene care for four clients to an assistive
personnel (AP). Which client should the nurse not assign to the AP?
A. 72-year-old with left-sided hemiparesis 1-day post-CVA
B. 55-year-old with newly diagnosed DM learning to self-inject insulin
C. 80-year-old with stage III pressure injury on coccyx
D. 60-year-old 2-days post-hip replacement with continuous SCDs
Q3. A fire alarm sounds on the unit. According to the RACE mnemonic, which
action is second?
A. Extinguish the fire
B. Activate the alarm
C. Confine the fire
D. Rescue clients
Q4. Which finding best indicates that a client’s restraints are applied
appropriately?
A. Two fingers slide easily between restraint and skin
B. Restraint is tied to the side-railed bed frame
C. Client can turn side-to-side without moving the restrained extremity
D. Skin under restraint is pale and cool
,Q5. The nurse receives a blood unit from the lab at 09:30. Administration must
begin no later than:
A. 10:00
B. 10:30
C. 11:00
D. 11:30
Q6. The nurse notes 2 mL of clear fluid in the J-tube before administering
medication. Which action is correct?
A. Discard the fluid
B. Return the fluid to the tube and proceed
C. Flush with 30 mL normal saline
D. Clamp tube for 30 min
Q7. A client is on contact precautions for VRE in the wound. Which action
violates infection-control principles?
A. Donning gown and gloves upon room entry
B. Removing PPE inside the anteroom before exiting
C. Sharing a stethoscope dedicated to this client only
D. Using disposable equipment when possible
Q8. The nurse is supervising a new RN preparing chemotherapy. Which action
requires immediate intervention?
A. Wearing a fit-tested N95 respirator
B. Double-gloving with powder-free gloves
C. Priming IV line with sterile water
D. Labeling fluid as “hazardous”
Q9. A confused elder tries to climb out of bed. Which least-restrictive intervention
should the nurse try first?
A. Bilateral soft wrist restraints
B. Enclosed bed net
C. Bed-exit alarm and hourly rounding
D. Vest restraint
Q10. A nurse is pulled to a cardiac step-down unit. Which assignment is unsafe
for this floating nurse?
A. Post-MI client on telemetry
B. Pre-heart-catheterization teaching
, C. Fresh post-op CABG day-0 in ICU on IABP
D. Stable HF client awaiting discharge
Q11. A client on warfarin has an INR of 5.8. The physician orders 2.5 mg vitamin
K IV. Available: 5 mg/1 mL. How many mL should the nurse administer?
A. 0.25 mL
B. 0.5 mL
C. 1 mL
D. 2 mL
Q12. While verifying pediatric dosages, the nurse notes cefazolin 1 g IV ordered
for a 6-year-old weighing 22 kg. Safe range is 25–50 mg/kg/dose q8h. The dose is:
A. Within safe low range
B. Within safe high range
C. Double the safe dose
D. Triple the safe dose
Q13. The nurse discovers she gave hydralazine 25 mg instead of ordered
hydroxyzine 25 mg. Which action reflects proper error management?
A. Complete an incident report before the end of shift
B. Notify the provider after assessing the client
C. Blame pharmacy for similar packaging
D. Document only in the MAR
Q14. A client reports “something went wrong” when the previous nurse gave
heparin. The investigating nurse should:
A. Ask the previous nurse in front of the client for transparency
B. Review the bar-code scanning record first
C. Re-administer the dose to be sure
D. Tell the client heparin is safe
Q15. Which statement by a UAP indicates correct understanding of hand hygiene?
A. “I use hand gel after removing gloves only if hands look dirty.”
B. “Alcohol gel is OK after contact with a client who has C. diff.”
C. “I wash with soap and water when visibly soiled.”
D. “I don’t need gel after taking a BP if I wore gloves.”
Q16. A 68-kg client is to receive a 500 mL bolus over 30 min using 20 g IV set (1
mL = 10 gtt). The flow rate is:
A. 167 gtt/min
