NR 224: Fundamentals of Nursing Final Exam - Version 1 (2026/2027
Update) |Chamberlain
1. A nurse is preparing to administer an intramuscular injection to an adult
client. Which site is the preferred location due to the absence of large blood
vessels and nerves?
A. Dorsogluteal
B. Deltoid
C. Ventrogluteal
D. Vastus lateralis
Answer: C
Rationale: The ventrogluteal site is the preferred site for IM injections in adults because it
is situated deep and away from major nerves and blood vessels.
2. When performing an abdominal assessment, in which order should the nurse
perform the physical examination techniques?
A. Inspection, Palpation, Percussion, Auscultation
B. Palpation, Percussion, Auscultation, Inspection
C. Inspection, Auscultation, Percussion, Palpation
D. Auscultation, Inspection, Palpation, Percussion
Answer: C
Rationale: For the abdomen, auscultation is performed before percussion and palpation to
avoid stimulating bowel sounds which might alter the assessment findings.
,3. A nurse is caring for a client who is at risk for skin breakdown. Which stage
describes a pressure injury with non-blanchable erythema of intact skin?
A. Unstageable
B. Stage 2
C. Stage 3
D. Stage 1
Answer: D
Rationale: Stage 1 pressure injuries consist of intact skin with localized non-blanchable
redness, usually over a bony prominence.
4. Which of the following is the most effective method to prevent the spread of
infection in a healthcare setting?
A. Wearing a mask for all patient contact
B. Administering prophylactic antibiotics
C. Performing proper hand hygiene
D. Using sterile gloves for all procedures
Answer: C
Rationale: Hand hygiene is widely recognized as the single most important practice to
reduce the transmission of infectious agents.
5. A client is scheduled for surgery. The nurse’s primary responsibility regarding
informed consent is to:
A. Witness the client’s signature on the consent form
B. Verify that the client understands the procedure
C. Explain the risks and benefits of the procedure
D. Obtain the signature if the doctor is busy
Answer: A
Rationale: The physician is responsible for explaining the procedure; the nurse’s role is to
witness the client signing the form and ensure the signature is authentic.
, 6. What is the priority nursing action when a nurse discovers a medication error
has occurred?
A. Assess the client’s condition and vital signs
B. Complete an incident report immediately
C. Notify the healthcare provider
D. Inform the nurse manager
Answer: A
Rationale: Client safety is the priority. The nurse must first assess the client for any
adverse effects before taking administrative or reporting actions.
7. A nurse is teaching a client about a high-fiber diet. Which food choice
indicates that the client understands the teaching?
A. White bread
B. Black beans
C. Canned peaches
D. White rice
Answer: B
Rationale: Legumes, such as black beans, are excellent sources of dietary fiber compared
to processed grains like white bread or rice.
8. Which nursing diagnosis has the highest priority according to Maslow’s
Hierarchy of Needs?
A. Risk for Falls
B. Ineffective Airway Clearance
C. Social Isolation
D. Disturbed Body Image
Answer: B
Rationale: Physiological needs, particularly airway and breathing, are at the base of
Maslow’s hierarchy and take precedence over safety, social, or esteem needs.
Update) |Chamberlain
1. A nurse is preparing to administer an intramuscular injection to an adult
client. Which site is the preferred location due to the absence of large blood
vessels and nerves?
A. Dorsogluteal
B. Deltoid
C. Ventrogluteal
D. Vastus lateralis
Answer: C
Rationale: The ventrogluteal site is the preferred site for IM injections in adults because it
is situated deep and away from major nerves and blood vessels.
2. When performing an abdominal assessment, in which order should the nurse
perform the physical examination techniques?
A. Inspection, Palpation, Percussion, Auscultation
B. Palpation, Percussion, Auscultation, Inspection
C. Inspection, Auscultation, Percussion, Palpation
D. Auscultation, Inspection, Palpation, Percussion
Answer: C
Rationale: For the abdomen, auscultation is performed before percussion and palpation to
avoid stimulating bowel sounds which might alter the assessment findings.
,3. A nurse is caring for a client who is at risk for skin breakdown. Which stage
describes a pressure injury with non-blanchable erythema of intact skin?
A. Unstageable
B. Stage 2
C. Stage 3
D. Stage 1
Answer: D
Rationale: Stage 1 pressure injuries consist of intact skin with localized non-blanchable
redness, usually over a bony prominence.
4. Which of the following is the most effective method to prevent the spread of
infection in a healthcare setting?
A. Wearing a mask for all patient contact
B. Administering prophylactic antibiotics
C. Performing proper hand hygiene
D. Using sterile gloves for all procedures
Answer: C
Rationale: Hand hygiene is widely recognized as the single most important practice to
reduce the transmission of infectious agents.
5. A client is scheduled for surgery. The nurse’s primary responsibility regarding
informed consent is to:
A. Witness the client’s signature on the consent form
B. Verify that the client understands the procedure
C. Explain the risks and benefits of the procedure
D. Obtain the signature if the doctor is busy
Answer: A
Rationale: The physician is responsible for explaining the procedure; the nurse’s role is to
witness the client signing the form and ensure the signature is authentic.
, 6. What is the priority nursing action when a nurse discovers a medication error
has occurred?
A. Assess the client’s condition and vital signs
B. Complete an incident report immediately
C. Notify the healthcare provider
D. Inform the nurse manager
Answer: A
Rationale: Client safety is the priority. The nurse must first assess the client for any
adverse effects before taking administrative or reporting actions.
7. A nurse is teaching a client about a high-fiber diet. Which food choice
indicates that the client understands the teaching?
A. White bread
B. Black beans
C. Canned peaches
D. White rice
Answer: B
Rationale: Legumes, such as black beans, are excellent sources of dietary fiber compared
to processed grains like white bread or rice.
8. Which nursing diagnosis has the highest priority according to Maslow’s
Hierarchy of Needs?
A. Risk for Falls
B. Ineffective Airway Clearance
C. Social Isolation
D. Disturbed Body Image
Answer: B
Rationale: Physiological needs, particularly airway and breathing, are at the base of
Maslow’s hierarchy and take precedence over safety, social, or esteem needs.
