NU 301 Unit 6 Exam: NCLEX-Style Fundamentals of Nursing -
with Rationales - 240 Questions and Answers Already Graded A+
Premium Exam Tested And Verified
Subject Area Fundamentals of Nursing
Description This exam covers core nursing fundamentals including evidence-based practice,
patient safety, infection control, pharmacology, fluid and electrolyte balance,
perioperative care, and ethical/legal principles. Questions are designed to test
clinical reasoning and application of the nursing process at an advanced
undergraduate level.
Expected Grade A+
Total Questions 240
Duration 3 hours
Learning Outcomes 1. Apply the nursing process to prioritize care for patients with complex needs.
2. Integrate evidence-based infection control measures in clinical scenarios.
3. Analyze fluid and electrolyte imbalances and select appropriate nursing
interventions.
4. Evaluate safe medication administration practices including dosage
calculations.
5. Interpret ethical and legal principles in nursing practice.
Accreditation This exam aligns with the standards of the Commission on Collegiate Nursing
Education (CCNE) and the NCLEX-RN test plan.
Page 1
,1. A nurse is evaluating a patient's arterial blood gas results: pH 7.30, PaCO2 50 mm
Hg, HCO3- 24 mEq/L. The nurse recognizes this as an acute uncompensated
respiratory acidosis. Which of the following is the most appropriate initial nursing
action?
A. Administer intravenous sodium bicarbonate
B. Increase the oxygen flow rate to 6 L/min via nasal cannula
C. Assess the patient's respiratory rate and depth, and prepare to assist with ventilation
D. Administer a bronchodilator as prescribed
Answer: C. Assess the patient's respiratory rate and depth, and prepare to assist
with ventilation
In acute respiratory acidosis, the primary problem is hypoventilation leading to CO2
retention. The priority is to improve ventilation. Administering sodium bicarbonate is
not indicated as the acidosis is respiratory, not metabolic. Increasing oxygen without
addressing ventilation may worsen hypercapnia. Bronchodilators may be helpful if
bronchospasm is present, but the initial action is to assess and support ventilation.
2. A nurse is preparing to administer a blood transfusion to a patient. Which of the
following findings requires immediate action before starting the transfusion?
A. The patient's temperature is 37.2°C (99°F)
B. The blood bag is 30 minutes old from the blood bank
C. The patient's intravenous line is a 22-gauge catheter in the forearm
D. The patient reports a history of a mild allergic reaction to blood transfusions in the past
Answer: D. The patient reports a history of a mild allergic reaction to blood
transfusions in the past
A history of allergic reaction indicates the patient is at risk for a transfusion reaction.
The nurse should ensure that premedication (e.g., antihistamines) is prescribed and that
emergency medications are available. Slight temperature elevation is not a
contraindication. Blood should be transfused within 4 hours of release from the blood
bank, so 30 minutes is acceptable. A 22-gauge catheter is appropriate for blood
transfusion unless rapid infusion is needed.
Page 2
,3. A nurse is caring for a patient with a central venous catheter who develops sudden
dyspnea, tachycardia, and hypotension after the nurse flushes the line. The nurse
suspects an air embolism. Which of the following actions should the nurse take first?
A. Place the patient in Trendelenburg position on the left side
B. Administer oxygen via non-rebreather mask at 15 L/min
C. Clamp the catheter immediately
D. Notify the healthcare provider
Answer: A. Place the patient in Trendelenburg position on the left side
The priority intervention for suspected air embolism is to prevent the air from traveling
to the pulmonary circulation. Placing the patient in Trendelenburg position on the left
side (Durant's maneuver) traps air in the right atrium. Administering oxygen is
important but secondary. Clamping the catheter may be done after positioning.
Notification is important but not the first action.
4. A nurse is assessing a patient who has been on bed rest for 3 days. Which of the
following findings is most indicative of a deep vein thrombosis (DVT)?
A. Calf tenderness and warmth with a positive Homan's sign
B. Unilateral leg swelling and erythema with palpable cord
C. Bilateral lower extremity edema and pitting edema
D. Pain in the leg upon dorsiflexion of the foot
Answer: B. Unilateral leg swelling and erythema with palpable cord
Unilateral leg swelling, erythema, and a palpable cord are classic signs of DVT.
Homan's sign (pain on dorsiflexion) is an unreliable and potentially dangerous test that
may dislodge a clot. Bilateral edema is more consistent with fluid overload or venous
insufficiency. Pain on dorsiflexion is not specific.
Page 3
, 5. A nurse is calculating the intake and output for a patient over 8 hours. The patient
consumed 240 mL of coffee, 120 mL of orange juice, and 180 mL of water. The
patient also received 500 mL of 0.9% normal saline intravenously. The output from
a Foley catheter is 800 mL. What is the net fluid balance?
A. +240 mL
B. +360 mL
C. +540 mL
D. +600 mL
Answer: A. +240 mL
Total intake = 240 (coffee) + 120 (juice) + 180 (water) + 500 (IV) = 1040 mL. Output =
800 mL. Net balance = 1040 - 800 = +240 mL. This indicates a positive balance, which
may be appropriate depending on the patient's clinical status.
6. A nurse is teaching a patient about the use of a patient-controlled analgesia (PCA)
pump. Which of the following statements by the patient indicates a need for further
teaching?
A. I should press the button when I start to feel pain, before it gets severe.
B. I can ask my family to press the button if I am asleep.
C. The pump has a lockout interval to prevent overdose.
D. I will report any nausea or itching to the nurse.
Answer: B. I can ask my family to press the button if I am asleep.
Only the patient should press the PCA button to ensure safe and effective pain
management. Family members pressing the button could lead to oversedation and
respiratory depression. The other statements are correct: pressing the button early
helps control pain, lockout intervals prevent overdose, and reporting side effects is
appropriate.
Page 4
with Rationales - 240 Questions and Answers Already Graded A+
Premium Exam Tested And Verified
Subject Area Fundamentals of Nursing
Description This exam covers core nursing fundamentals including evidence-based practice,
patient safety, infection control, pharmacology, fluid and electrolyte balance,
perioperative care, and ethical/legal principles. Questions are designed to test
clinical reasoning and application of the nursing process at an advanced
undergraduate level.
Expected Grade A+
Total Questions 240
Duration 3 hours
Learning Outcomes 1. Apply the nursing process to prioritize care for patients with complex needs.
2. Integrate evidence-based infection control measures in clinical scenarios.
3. Analyze fluid and electrolyte imbalances and select appropriate nursing
interventions.
4. Evaluate safe medication administration practices including dosage
calculations.
5. Interpret ethical and legal principles in nursing practice.
Accreditation This exam aligns with the standards of the Commission on Collegiate Nursing
Education (CCNE) and the NCLEX-RN test plan.
Page 1
,1. A nurse is evaluating a patient's arterial blood gas results: pH 7.30, PaCO2 50 mm
Hg, HCO3- 24 mEq/L. The nurse recognizes this as an acute uncompensated
respiratory acidosis. Which of the following is the most appropriate initial nursing
action?
A. Administer intravenous sodium bicarbonate
B. Increase the oxygen flow rate to 6 L/min via nasal cannula
C. Assess the patient's respiratory rate and depth, and prepare to assist with ventilation
D. Administer a bronchodilator as prescribed
Answer: C. Assess the patient's respiratory rate and depth, and prepare to assist
with ventilation
In acute respiratory acidosis, the primary problem is hypoventilation leading to CO2
retention. The priority is to improve ventilation. Administering sodium bicarbonate is
not indicated as the acidosis is respiratory, not metabolic. Increasing oxygen without
addressing ventilation may worsen hypercapnia. Bronchodilators may be helpful if
bronchospasm is present, but the initial action is to assess and support ventilation.
2. A nurse is preparing to administer a blood transfusion to a patient. Which of the
following findings requires immediate action before starting the transfusion?
A. The patient's temperature is 37.2°C (99°F)
B. The blood bag is 30 minutes old from the blood bank
C. The patient's intravenous line is a 22-gauge catheter in the forearm
D. The patient reports a history of a mild allergic reaction to blood transfusions in the past
Answer: D. The patient reports a history of a mild allergic reaction to blood
transfusions in the past
A history of allergic reaction indicates the patient is at risk for a transfusion reaction.
The nurse should ensure that premedication (e.g., antihistamines) is prescribed and that
emergency medications are available. Slight temperature elevation is not a
contraindication. Blood should be transfused within 4 hours of release from the blood
bank, so 30 minutes is acceptable. A 22-gauge catheter is appropriate for blood
transfusion unless rapid infusion is needed.
Page 2
,3. A nurse is caring for a patient with a central venous catheter who develops sudden
dyspnea, tachycardia, and hypotension after the nurse flushes the line. The nurse
suspects an air embolism. Which of the following actions should the nurse take first?
A. Place the patient in Trendelenburg position on the left side
B. Administer oxygen via non-rebreather mask at 15 L/min
C. Clamp the catheter immediately
D. Notify the healthcare provider
Answer: A. Place the patient in Trendelenburg position on the left side
The priority intervention for suspected air embolism is to prevent the air from traveling
to the pulmonary circulation. Placing the patient in Trendelenburg position on the left
side (Durant's maneuver) traps air in the right atrium. Administering oxygen is
important but secondary. Clamping the catheter may be done after positioning.
Notification is important but not the first action.
4. A nurse is assessing a patient who has been on bed rest for 3 days. Which of the
following findings is most indicative of a deep vein thrombosis (DVT)?
A. Calf tenderness and warmth with a positive Homan's sign
B. Unilateral leg swelling and erythema with palpable cord
C. Bilateral lower extremity edema and pitting edema
D. Pain in the leg upon dorsiflexion of the foot
Answer: B. Unilateral leg swelling and erythema with palpable cord
Unilateral leg swelling, erythema, and a palpable cord are classic signs of DVT.
Homan's sign (pain on dorsiflexion) is an unreliable and potentially dangerous test that
may dislodge a clot. Bilateral edema is more consistent with fluid overload or venous
insufficiency. Pain on dorsiflexion is not specific.
Page 3
, 5. A nurse is calculating the intake and output for a patient over 8 hours. The patient
consumed 240 mL of coffee, 120 mL of orange juice, and 180 mL of water. The
patient also received 500 mL of 0.9% normal saline intravenously. The output from
a Foley catheter is 800 mL. What is the net fluid balance?
A. +240 mL
B. +360 mL
C. +540 mL
D. +600 mL
Answer: A. +240 mL
Total intake = 240 (coffee) + 120 (juice) + 180 (water) + 500 (IV) = 1040 mL. Output =
800 mL. Net balance = 1040 - 800 = +240 mL. This indicates a positive balance, which
may be appropriate depending on the patient's clinical status.
6. A nurse is teaching a patient about the use of a patient-controlled analgesia (PCA)
pump. Which of the following statements by the patient indicates a need for further
teaching?
A. I should press the button when I start to feel pain, before it gets severe.
B. I can ask my family to press the button if I am asleep.
C. The pump has a lockout interval to prevent overdose.
D. I will report any nausea or itching to the nurse.
Answer: B. I can ask my family to press the button if I am asleep.
Only the patient should press the PCA button to ensure safe and effective pain
management. Family members pressing the button could lead to oversedation and
respiratory depression. The other statements are correct: pressing the button early
helps control pain, lockout intervals prevent overdose, and reporting side effects is
appropriate.
Page 4
