FUNDAMENTALS OF NURSING COMPETENCY
ASSESSMENT| Summer Series Practice Test|
June/July 2026 |Questions And Correct Answers
1. A nurse is preparing to administer a medication that has a high first-
pass effect. Which route of administration should the nurse anticipate
will be ordered to bypass this effect?
A. Oral
B. Sublingual
C. Rectal
D. Intravenous
Correct Answer: B
Explanation: The sublingual route bypasses the hepatic portal system
and first-pass metabolism, allowing the drug to enter systemic
circulation directly. Oral (A) and rectal (C) routes undergo varying
degrees of first-pass effect. Intravenous (D) also bypasses the first-pass
effect but is not specifically indicated for this purpose in the question.
2. A patient with a history of chronic obstructive pulmonary disease
(COPD) has an order for oxygen at 2 L/min via nasal cannula. The
nurse observes the patient’s respiratory rate has decreased to 8
breaths per minute. Which is the priority nursing action?
A. Increase the oxygen flow rate to 4 L/min
B. Place the patient in a high-Fowler’s position
C. Assess the patient’s oxygen saturation level
D. Notify the healthcare provider immediately
,Correct Answer: C
Explanation: The nurse must first assess the patient's oxygen saturation
to determine if the decreased respiratory rate is causing hypoxia or if it
is a sign of carbon dioxide narcosis. Increasing oxygen (A) could worsen
hypoventilation in a COPD patient. Positioning (B) is helpful but not the
priority. Notifying the provider (D) is appropriate after assessing the
patient.
3. When performing a sterile dressing change, the nurse drops a sterile
gauze pad onto the sterile field, but it lands outside the 2-inch border.
What is the appropriate action?
A. Use the gauze pad as it is still within the sterile field
B. Discard the gauze pad and obtain a new one
C. Move the gauze pad to the center of the sterile field using sterile
forceps
D. Continue with the dressing change and use a different sterile pad
Correct Answer: B
Explanation: The 1-inch (often 2-inch) border of a sterile field is
considered unsterile. Any object that falls outside this border is
contaminated and must be discarded. Using it (A) or moving it (C) would
breach sterile technique. Continuing without it (D) may be necessary but
the action of discarding it is the correct step.
4. A nurse is calculating the intake for a patient. The patient received
750 mL of intravenous fluids, 240 mL of ice chips, and 150 mL of water
from a meal. What is the total intake in mL?
A. 1,140 mL
,B. 1,140 mL
C. 1,020 mL
D. 990 mL
Correct Answer: C
Explanation: Ice chips are recorded as half their volume when melted
(240 mL of ice chips = 120 mL of water). The total intake is 750 mL (IV) +
120 mL (ice chips) + 150 mL (water) = 1,020 mL. Options A, B, and D are
incorrect calculations.
5. The nurse is assessing a patient who is receiving a blood
transfusion. The patient develops chills, flank pain, and dark urine.
Which type of transfusion reaction is the patient most likely
experiencing?
A. Febrile reaction
B. Acute hemolytic reaction
C. Allergic reaction
D. Transfusion-associated circulatory overload
Correct Answer: B
Explanation: The classic triad of an acute hemolytic reaction includes
chills, flank pain, and dark urine (hemoglobinuria) due to red blood cell
destruction. Febrile reactions (A) present with fever and chills but no
flank pain or dark urine. Allergic reactions (C) cause urticaria and
pruritus. Circulatory overload (D) manifests as dyspnea, crackles, and
hypertension.
6. A patient has a nasogastric (NG) tube connected to continuous
suction. Which assessment finding indicates that the tube is
, functioning properly?
A. The patient reports a dry mouth
B. The gastric aspirate has a pH of 5
C. The nurse hears a whooshing sound when instilling 20 mL of air
D. The drainage is absent and the patient is nauseous
Correct Answer: B
Explanation: A gastric aspirate pH of 5 is consistent with gastric
secretions, indicating the tube is properly placed in the stomach. Dry
mouth (A) is a common side effect but not a sign of proper function. The
whooshing sound (C) is not a standard or reliable method for confirming
placement. Absent drainage and nausea (D) could indicate tube
blockage or displacement.
7. The nurse is preparing to administer an intramuscular (IM) injection
to an adult patient in the ventrogluteal site. Which action is essential
to ensure safe administration?
A. Spread the skin taut over the injection site
B. Use the Z-track method to prevent leakage
C. Aspirate for blood before injecting the medication
D. Insert the needle at a 45-degree angle
Correct Answer: C
Explanation: Aspiration for blood is recommended for IM injections to
avoid accidental intravascular injection. The ventrogluteal site is deep
and free from major nerves and vessels. Spreading the skin taut (A) is a
technique used for subcutaneous injections. The Z-track method (B) is
used for IM injections but is not specific to the ventrogluteal site. A 45-
degree angle (D) is used for subcutaneous injections, not IM.
ASSESSMENT| Summer Series Practice Test|
June/July 2026 |Questions And Correct Answers
1. A nurse is preparing to administer a medication that has a high first-
pass effect. Which route of administration should the nurse anticipate
will be ordered to bypass this effect?
A. Oral
B. Sublingual
C. Rectal
D. Intravenous
Correct Answer: B
Explanation: The sublingual route bypasses the hepatic portal system
and first-pass metabolism, allowing the drug to enter systemic
circulation directly. Oral (A) and rectal (C) routes undergo varying
degrees of first-pass effect. Intravenous (D) also bypasses the first-pass
effect but is not specifically indicated for this purpose in the question.
2. A patient with a history of chronic obstructive pulmonary disease
(COPD) has an order for oxygen at 2 L/min via nasal cannula. The
nurse observes the patient’s respiratory rate has decreased to 8
breaths per minute. Which is the priority nursing action?
A. Increase the oxygen flow rate to 4 L/min
B. Place the patient in a high-Fowler’s position
C. Assess the patient’s oxygen saturation level
D. Notify the healthcare provider immediately
,Correct Answer: C
Explanation: The nurse must first assess the patient's oxygen saturation
to determine if the decreased respiratory rate is causing hypoxia or if it
is a sign of carbon dioxide narcosis. Increasing oxygen (A) could worsen
hypoventilation in a COPD patient. Positioning (B) is helpful but not the
priority. Notifying the provider (D) is appropriate after assessing the
patient.
3. When performing a sterile dressing change, the nurse drops a sterile
gauze pad onto the sterile field, but it lands outside the 2-inch border.
What is the appropriate action?
A. Use the gauze pad as it is still within the sterile field
B. Discard the gauze pad and obtain a new one
C. Move the gauze pad to the center of the sterile field using sterile
forceps
D. Continue with the dressing change and use a different sterile pad
Correct Answer: B
Explanation: The 1-inch (often 2-inch) border of a sterile field is
considered unsterile. Any object that falls outside this border is
contaminated and must be discarded. Using it (A) or moving it (C) would
breach sterile technique. Continuing without it (D) may be necessary but
the action of discarding it is the correct step.
4. A nurse is calculating the intake for a patient. The patient received
750 mL of intravenous fluids, 240 mL of ice chips, and 150 mL of water
from a meal. What is the total intake in mL?
A. 1,140 mL
,B. 1,140 mL
C. 1,020 mL
D. 990 mL
Correct Answer: C
Explanation: Ice chips are recorded as half their volume when melted
(240 mL of ice chips = 120 mL of water). The total intake is 750 mL (IV) +
120 mL (ice chips) + 150 mL (water) = 1,020 mL. Options A, B, and D are
incorrect calculations.
5. The nurse is assessing a patient who is receiving a blood
transfusion. The patient develops chills, flank pain, and dark urine.
Which type of transfusion reaction is the patient most likely
experiencing?
A. Febrile reaction
B. Acute hemolytic reaction
C. Allergic reaction
D. Transfusion-associated circulatory overload
Correct Answer: B
Explanation: The classic triad of an acute hemolytic reaction includes
chills, flank pain, and dark urine (hemoglobinuria) due to red blood cell
destruction. Febrile reactions (A) present with fever and chills but no
flank pain or dark urine. Allergic reactions (C) cause urticaria and
pruritus. Circulatory overload (D) manifests as dyspnea, crackles, and
hypertension.
6. A patient has a nasogastric (NG) tube connected to continuous
suction. Which assessment finding indicates that the tube is
, functioning properly?
A. The patient reports a dry mouth
B. The gastric aspirate has a pH of 5
C. The nurse hears a whooshing sound when instilling 20 mL of air
D. The drainage is absent and the patient is nauseous
Correct Answer: B
Explanation: A gastric aspirate pH of 5 is consistent with gastric
secretions, indicating the tube is properly placed in the stomach. Dry
mouth (A) is a common side effect but not a sign of proper function. The
whooshing sound (C) is not a standard or reliable method for confirming
placement. Absent drainage and nausea (D) could indicate tube
blockage or displacement.
7. The nurse is preparing to administer an intramuscular (IM) injection
to an adult patient in the ventrogluteal site. Which action is essential
to ensure safe administration?
A. Spread the skin taut over the injection site
B. Use the Z-track method to prevent leakage
C. Aspirate for blood before injecting the medication
D. Insert the needle at a 45-degree angle
Correct Answer: C
Explanation: Aspiration for blood is recommended for IM injections to
avoid accidental intravascular injection. The ventrogluteal site is deep
and free from major nerves and vessels. Spreading the skin taut (A) is a
technique used for subcutaneous injections. The Z-track method (B) is
used for IM injections but is not specific to the ventrogluteal site. A 45-
degree angle (D) is used for subcutaneous injections, not IM.
