Fall Semester 2026–2027 FUNDAMENTAL CMS Proctored NCLEX, ATI & HESI Study
Guide Updated 2026 | 190+ Questions and Answers | Fundamentals of Nursing
Comprehensive Study Guide, Practice Exam, Exam Prep Test Bank for Unitek,
Rasmussen, Chamberlain, WGU & Excelsior | ATI CMS Fundamentals, HESI
Fundamentals, NCLEX-RN Review, Patient Safety, Infection Prevention,
Pharmacology Basics, Clinical Judgment, Prioritization, Delegation, Detailed
Rationales and Complete Revision Material
Question 1: A client with a history of chronic obstructive pulmonary disease
(COPD) is admitted with acute respiratory distress. The nurse notes the client
is using accessory muscles and has a pulse oximetry reading of 88% on room
air. Which of the following actions should the nurse take FIRST?
A. Prepare for immediate endotracheal intubation.
B. Administer oxygen via a non-rebreather mask at 15 L/min.
C. Position the client in a high-Fowler's position and encourage pursed-lip breathing.
D. Notify the healthcare provider for an order for arterial blood gases.
CORRECT ANSWER: C. Position the client in a high-Fowler's position and
encourage pursed-lip breathing.
Rationale: Positioning the client in high-Fowler's and encouraging pursed-lip breathing
maximizes lung expansion and airway pressure, which is an immediate, non-invasive
nursing intervention. High-flow oxygen may suppress the hypoxic drive in a COPD
client, so it is not the first action. Intubation and ABGs are important but not the
immediate priority before simpler interventions are initiated.
Question 2: A nurse is caring for a client who is 2 days post-operative
following a right-sided mastectomy. Which of the following assessment
findings is the priority to report to the healthcare provider?
A. Serosanguinous drainage on the surgical dressing.
B. Client reports a pain level of 4 on a 0-10 scale.
C. Temperature of 100.4°F (38°C) and swelling in the right arm.
D. Client reports numbness and tingling in the right hand.
CORRECT ANSWER: C. Temperature of 100.4°F (38°C) and swelling in the right
arm.
Rationale: This combination of findings suggests a developing infection or lymphedema,
which is a serious complication. While drainage and pain are expected, fever and
swelling indicate a need for immediate evaluation. Numbness may be related to nerve
involvement but is less immediately life-threatening than sepsis.
Question 3: A nurse is preparing a client for a cardiac catheterization via the
femoral artery. Which of the following actions should the nurse take to prevent
a potential complication?
,A. Maintain the client on strict bed rest with the affected leg extended post-procedure.
B. Instruct the client to perform the Valsalva maneuver during sheath removal.
C. Administer a prescribed dose of oral anticoagulant 2 hours before the procedure.
D. Ensure the client is NPO for 12 hours prior to the procedure.
CORRECT ANSWER: A. Maintain the client on strict bed rest with the affected
leg extended post-procedure.
Rationale: Keeping the affected leg extended and straight prevents kinking of the
femoral artery, which can lead to thrombus formation or bleeding. The Valsalva
maneuver increases bleeding risk, anticoagulants are typically held, and NPO is usually
4-6 hours, not 12.
Question 4: A nurse is monitoring a client receiving a blood transfusion. Which
of the following findings indicates an acute hemolytic transfusion reaction?
A. Flushing and itching of the skin.
B. Sudden low back pain and chills with fever.
C. Wheezing and stridor.
D. Nausea and vomiting 2 hours after the transfusion.
CORRECT ANSWER: B. Sudden low back pain and chills with fever.
Rationale: Acute hemolytic reactions occur due to ABO incompatibility. The classic
signs include low back pain, chills, fever, and hypotension as red blood cells are
destroyed. Flushing and itching suggest a mild allergic reaction, and wheezing suggests
anaphylaxis, which is a different pathophysiology.
Question 5: A client is prescribed furosemide (Lasix) 40 mg IV push. Which of
the following laboratory values should the nurse monitor most closely before
administering this medication?
A. Serum sodium.
B. Serum potassium.
C. Serum calcium.
D. Serum creatinine.
CORRECT ANSWER: B. Serum potassium.
Rationale: Furosemide is a loop diuretic that causes significant potassium loss in the
distal tubule. Hypokalemia can lead to cardiac arrhythmias. While sodium, calcium, and
renal function are monitored, potassium is the most critical electrolyte to assess prior to
administration to prevent life-threatening complications.
,Question 6: A nurse is teaching a client with a new diagnosis of type 2 diabetes
mellitus about foot care. Which of the following statements by the client
indicates an understanding of the teaching?
A. "I will soak my feet in hot water for 10 minutes each night."
B. "I should use a heating pad to keep my feet warm if they feel cold."
C. "I will cut my toenails straight across and file the edges."
D. "I can treat minor cuts with iodine and a bandage."
CORRECT ANSWER: C. "I will cut my toenails straight across and file the
edges."
Rationale: Cutting toenails straight across prevents ingrown toenails, which can lead to
infection and ulceration. Soaking in hot water, using heating pads, and using harsh
chemicals like iodine are contraindicated due to neuropathy and poor circulation.
Question 7: A client is admitted with a suspected pulmonary embolism. Which
of the following diagnostic tests provides the most definitive diagnosis?
A. D-dimer blood test.
B. Chest X-ray.
C. Computed tomography pulmonary angiography (CTPA).
D. Ventilation-perfusion (V/Q) scan.
CORRECT ANSWER: C. Computed tomography pulmonary angiography
(CTPA).
Rationale: CTPA is the gold standard for diagnosing pulmonary embolism with high
sensitivity and specificity. A D-dimer is a screening test but not definitive. V/Q scans are
used but are less specific, and chest X-rays are generally normal.
Question 8: A nurse is assessing a client with heart failure who has developed
shortness of breath and frothy pink sputum. Which of the following conditions
is the client most likely experiencing?
A. Cardiogenic shock.
B. Acute pulmonary edema.
C. Right-sided heart failure.
D. Pericardial effusion.
CORRECT ANSWER: B. Acute pulmonary edema.
Rationale: Frothy pink sputum and severe dyspnea are hallmark signs of acute
pulmonary edema, often caused by left-sided heart failure. This leads to fluid backing up
into the pulmonary capillaries and alveoli. Right-sided failure presents with peripheral
edema, and cardiogenic shock involves profound hypotension.
, Question 9: A client is receiving continuous enteral feedings through a
nasogastric tube. Which of the following actions should the nurse take to
prevent aspiration?
A. Check residual volumes every 8 hours.
B. Elevate the head of the bed to at least 30 degrees.
C. Flush the tube with 50 mL of sterile water every 2 hours.
D. Change the feeding bag and tubing every 48 hours.
CORRECT ANSWER: B. Elevate the head of the bed to at least 30 degrees.
Rationale: Keeping the head of the bed elevated to 30-45 degrees is a standard
intervention to prevent reflux and aspiration. Checking residuals every 4 hours is
typical, flushing prevents clogging, and tubing is changed every 24 hours to prevent
bacterial growth.
Question 10: A nurse is assessing a newborn infant and notes a heart rate of 90
beats per minute, irregular respirations, and a flaccid tone. According to the
Apgar scoring system, what is the priority nursing action?
A. Continue routine monitoring and reassess in 5 minutes.
B. Initiate vigorous drying and tactile stimulation.
C. Administer 100% oxygen via bag-mask ventilation.
D. Prepare for intubation and chest compressions.
CORRECT ANSWER: C. Administer 100% oxygen via bag-mask ventilation.
Rationale: A score of 0-3 is severely low and indicates the need for immediate positive
pressure ventilation. While drying and stimulation are for mild distress (score 4-6), this
presentation (score likely 0-2) requires immediate respiratory support. The Apgar score
was developed to assist in deciding when to initiate resuscitation.
Question 11: A client is prescribed digoxin (Lanoxin) for atrial fibrillation.
Which of the following signs would indicate digoxin toxicity?
A. Bradycardia and visual disturbances (yellow halos).
B. Tachycardia and hypertension.
C. Hyperkalemia and diarrhea.
D. Polyuria and muscle weakness.
CORRECT ANSWER: A. Bradycardia and visual disturbances (yellow halos).
Rationale: Digoxin toxicity presents with gastrointestinal symptoms (nausea, vomiting),
cardiac dysrhythmias (bradycardia, heart block), and neurologic symptoms such as
Guide Updated 2026 | 190+ Questions and Answers | Fundamentals of Nursing
Comprehensive Study Guide, Practice Exam, Exam Prep Test Bank for Unitek,
Rasmussen, Chamberlain, WGU & Excelsior | ATI CMS Fundamentals, HESI
Fundamentals, NCLEX-RN Review, Patient Safety, Infection Prevention,
Pharmacology Basics, Clinical Judgment, Prioritization, Delegation, Detailed
Rationales and Complete Revision Material
Question 1: A client with a history of chronic obstructive pulmonary disease
(COPD) is admitted with acute respiratory distress. The nurse notes the client
is using accessory muscles and has a pulse oximetry reading of 88% on room
air. Which of the following actions should the nurse take FIRST?
A. Prepare for immediate endotracheal intubation.
B. Administer oxygen via a non-rebreather mask at 15 L/min.
C. Position the client in a high-Fowler's position and encourage pursed-lip breathing.
D. Notify the healthcare provider for an order for arterial blood gases.
CORRECT ANSWER: C. Position the client in a high-Fowler's position and
encourage pursed-lip breathing.
Rationale: Positioning the client in high-Fowler's and encouraging pursed-lip breathing
maximizes lung expansion and airway pressure, which is an immediate, non-invasive
nursing intervention. High-flow oxygen may suppress the hypoxic drive in a COPD
client, so it is not the first action. Intubation and ABGs are important but not the
immediate priority before simpler interventions are initiated.
Question 2: A nurse is caring for a client who is 2 days post-operative
following a right-sided mastectomy. Which of the following assessment
findings is the priority to report to the healthcare provider?
A. Serosanguinous drainage on the surgical dressing.
B. Client reports a pain level of 4 on a 0-10 scale.
C. Temperature of 100.4°F (38°C) and swelling in the right arm.
D. Client reports numbness and tingling in the right hand.
CORRECT ANSWER: C. Temperature of 100.4°F (38°C) and swelling in the right
arm.
Rationale: This combination of findings suggests a developing infection or lymphedema,
which is a serious complication. While drainage and pain are expected, fever and
swelling indicate a need for immediate evaluation. Numbness may be related to nerve
involvement but is less immediately life-threatening than sepsis.
Question 3: A nurse is preparing a client for a cardiac catheterization via the
femoral artery. Which of the following actions should the nurse take to prevent
a potential complication?
,A. Maintain the client on strict bed rest with the affected leg extended post-procedure.
B. Instruct the client to perform the Valsalva maneuver during sheath removal.
C. Administer a prescribed dose of oral anticoagulant 2 hours before the procedure.
D. Ensure the client is NPO for 12 hours prior to the procedure.
CORRECT ANSWER: A. Maintain the client on strict bed rest with the affected
leg extended post-procedure.
Rationale: Keeping the affected leg extended and straight prevents kinking of the
femoral artery, which can lead to thrombus formation or bleeding. The Valsalva
maneuver increases bleeding risk, anticoagulants are typically held, and NPO is usually
4-6 hours, not 12.
Question 4: A nurse is monitoring a client receiving a blood transfusion. Which
of the following findings indicates an acute hemolytic transfusion reaction?
A. Flushing and itching of the skin.
B. Sudden low back pain and chills with fever.
C. Wheezing and stridor.
D. Nausea and vomiting 2 hours after the transfusion.
CORRECT ANSWER: B. Sudden low back pain and chills with fever.
Rationale: Acute hemolytic reactions occur due to ABO incompatibility. The classic
signs include low back pain, chills, fever, and hypotension as red blood cells are
destroyed. Flushing and itching suggest a mild allergic reaction, and wheezing suggests
anaphylaxis, which is a different pathophysiology.
Question 5: A client is prescribed furosemide (Lasix) 40 mg IV push. Which of
the following laboratory values should the nurse monitor most closely before
administering this medication?
A. Serum sodium.
B. Serum potassium.
C. Serum calcium.
D. Serum creatinine.
CORRECT ANSWER: B. Serum potassium.
Rationale: Furosemide is a loop diuretic that causes significant potassium loss in the
distal tubule. Hypokalemia can lead to cardiac arrhythmias. While sodium, calcium, and
renal function are monitored, potassium is the most critical electrolyte to assess prior to
administration to prevent life-threatening complications.
,Question 6: A nurse is teaching a client with a new diagnosis of type 2 diabetes
mellitus about foot care. Which of the following statements by the client
indicates an understanding of the teaching?
A. "I will soak my feet in hot water for 10 minutes each night."
B. "I should use a heating pad to keep my feet warm if they feel cold."
C. "I will cut my toenails straight across and file the edges."
D. "I can treat minor cuts with iodine and a bandage."
CORRECT ANSWER: C. "I will cut my toenails straight across and file the
edges."
Rationale: Cutting toenails straight across prevents ingrown toenails, which can lead to
infection and ulceration. Soaking in hot water, using heating pads, and using harsh
chemicals like iodine are contraindicated due to neuropathy and poor circulation.
Question 7: A client is admitted with a suspected pulmonary embolism. Which
of the following diagnostic tests provides the most definitive diagnosis?
A. D-dimer blood test.
B. Chest X-ray.
C. Computed tomography pulmonary angiography (CTPA).
D. Ventilation-perfusion (V/Q) scan.
CORRECT ANSWER: C. Computed tomography pulmonary angiography
(CTPA).
Rationale: CTPA is the gold standard for diagnosing pulmonary embolism with high
sensitivity and specificity. A D-dimer is a screening test but not definitive. V/Q scans are
used but are less specific, and chest X-rays are generally normal.
Question 8: A nurse is assessing a client with heart failure who has developed
shortness of breath and frothy pink sputum. Which of the following conditions
is the client most likely experiencing?
A. Cardiogenic shock.
B. Acute pulmonary edema.
C. Right-sided heart failure.
D. Pericardial effusion.
CORRECT ANSWER: B. Acute pulmonary edema.
Rationale: Frothy pink sputum and severe dyspnea are hallmark signs of acute
pulmonary edema, often caused by left-sided heart failure. This leads to fluid backing up
into the pulmonary capillaries and alveoli. Right-sided failure presents with peripheral
edema, and cardiogenic shock involves profound hypotension.
, Question 9: A client is receiving continuous enteral feedings through a
nasogastric tube. Which of the following actions should the nurse take to
prevent aspiration?
A. Check residual volumes every 8 hours.
B. Elevate the head of the bed to at least 30 degrees.
C. Flush the tube with 50 mL of sterile water every 2 hours.
D. Change the feeding bag and tubing every 48 hours.
CORRECT ANSWER: B. Elevate the head of the bed to at least 30 degrees.
Rationale: Keeping the head of the bed elevated to 30-45 degrees is a standard
intervention to prevent reflux and aspiration. Checking residuals every 4 hours is
typical, flushing prevents clogging, and tubing is changed every 24 hours to prevent
bacterial growth.
Question 10: A nurse is assessing a newborn infant and notes a heart rate of 90
beats per minute, irregular respirations, and a flaccid tone. According to the
Apgar scoring system, what is the priority nursing action?
A. Continue routine monitoring and reassess in 5 minutes.
B. Initiate vigorous drying and tactile stimulation.
C. Administer 100% oxygen via bag-mask ventilation.
D. Prepare for intubation and chest compressions.
CORRECT ANSWER: C. Administer 100% oxygen via bag-mask ventilation.
Rationale: A score of 0-3 is severely low and indicates the need for immediate positive
pressure ventilation. While drying and stimulation are for mild distress (score 4-6), this
presentation (score likely 0-2) requires immediate respiratory support. The Apgar score
was developed to assist in deciding when to initiate resuscitation.
Question 11: A client is prescribed digoxin (Lanoxin) for atrial fibrillation.
Which of the following signs would indicate digoxin toxicity?
A. Bradycardia and visual disturbances (yellow halos).
B. Tachycardia and hypertension.
C. Hyperkalemia and diarrhea.
D. Polyuria and muscle weakness.
CORRECT ANSWER: A. Bradycardia and visual disturbances (yellow halos).
Rationale: Digoxin toxicity presents with gastrointestinal symptoms (nausea, vomiting),
cardiac dysrhythmias (bradycardia, heart block), and neurologic symptoms such as
