NUR 106 - Fundamentals of Nursing Final Examination 100 Questions with Complete Solutions
NUR 106 - Fundamentals of Nursing
Final Examination
100 Questions With Complete Solutions
Cognitive Distribution: 25% Recall / 50%
Total Questions: 100
Application / 25% Analysis
Question Style: 70% Scenario-based / 20%
Format: Multiple Choice (4 options, one correct)
Application / 10% Recall
Passing Standard: Fundamentals of Nursing
Aligned with ANA Standards of Nursing Practice
Competency
SECTION 1: Fundamentals of Nursing Practice (Q1-Q20)
Nursing Process (ADPIE), Documentation, Communication, Delegation, and Legal/Ethical Principles
Q1: A nurse is caring for a 68-year-old patient admitted with heart failure exacerbation. After assessing
the patient and identifying bilateral crackles, 2+ pitting edema, and a weight gain of 4 pounds in 24
hours, the nurse documents the findings and notifies the provider. Which step of the nursing process
(ADPIE) is the nurse demonstrating?
A. Assessment [CORRECT]
B. Diagnosis
C. Planning
D. Implementation
Correct Answer: A — Assessment
Rationale: The nurse is performing Assessment, the first step of ADPIE, which involves the systematic collection of
subjective and objective data through history-taking, physical examination, and review of diagnostic findings.
Although the nurse documents and communicates findings, the act of gathering assessment data (crackles, edema,
weight gain) is the defining activity. Diagnosis would involve formulating a NANDA-I label such as 'Fluid Volume
Overload,' Planning involves setting measurable outcomes, and Implementation involves executing nursing
interventions.
Q2: A new graduate nurse is developing a care plan for a postoperative patient. Which nursing diagnosis
is written in the correct format according to NANDA-I guidelines?
A. Acute Pain related to surgical incision as evidenced by patient stating pain is 8/10 and guarding
behavior. [CORRECT]
B. Acute Pain related to surgery.
C. Acute Pain 8/10 requiring analgesia.
D. Surgical Pain manifested by patient distress and need for pain medication.
Correct Answer: A — Acute Pain related to surgical incision as evidenced by patient stating pain is 8/10 and
guarding behavior.
NUR 106 Final Exam - Complete Solutions Page 1
,NUR 106 - Fundamentals of Nursing Final Examination 100 Questions with Complete Solutions
Rationale: A correctly written NANDA-I nursing diagnosis contains three components: the problem (diagnostic
label), the etiology (related to factor), and the defining characteristics (as evidenced by signs/symptoms). Option A
includes all three elements. Option B omits defining characteristics, making the diagnosis unverifiable. Option C is
not a recognized diagnostic format and lacks the etiological factor. Option D uses incorrect terminology ('manifested
by') and does not follow the PES (Problem-Etiology-Symptoms) structure that guides nursing interventions.
Q3: A nurse is documenting a patient's response to pain medication in the electronic health record.
Which documentation entry represents the most complete and legally sound example?
A. Pt states pain improved. Med given.
B. Pt reports pain decreased from 8/10 to 3/10 thirty minutes after administration of morphine 4 mg
IV. Resting quietly with HR 76, BP 118/72, RR 16. No adverse effects observed. [CORRECT]
C. Pain medication effective. Pt comfortable.
D. Morphine 4 mg IV administered for pain. Pt appears better.
Correct Answer: B — Pt reports pain decreased from 8/10 to 3/10 thirty minutes after administration of
morphine 4 mg IV. Resting quietly with HR 76, BP 118/72, RR 16. No adverse effects observed.
Rationale: Option B exemplifies complete nursing documentation by including the intervention (medication, dose,
route, time), subjective reassessment (pain score before and after), objective findings (vital signs), and patient
response. This documentation meets legal standards because it is factual, measurable, timely, and reflects the nursing
process. Options A, C, and D contain vague terms ('improved,' 'comfortable,' 'appears better') that are subjective,
non-measurable, and fail to demonstrate the effectiveness of the intervention. Such documentation would not defend
the nurse in a malpractice claim.
Q4: A charge nurse on a medical-surgical unit is planning assignments for the shift. Which task is most
appropriate to delegate to a licensed practical nurse (LPN)?
A. Initial admission assessment of a patient transferred from the emergency department with chest pain.
B. Administering the first dose of a newly ordered IV antibiotic to a patient with a history of anaphylaxis.
C. Monitoring vital signs and wound care for a stable postoperative patient whose condition is
uncomplicated. [CORRECT]
D. Developing the discharge teaching plan for a patient with newly diagnosed heart failure.
Correct Answer: C — Monitoring vital signs and wound care for a stable postoperative patient whose
condition is uncomplicated.
Rationale: The LPN's scope of practice includes caring for stable patients with predictable outcomes and performing
routine tasks such as vital sign monitoring and wound care. Option C fits this scope because the patient is stable with
an uncomplicated recovery. The other tasks require the RN's broader assessment, critical thinking, and judgment:
initial assessments (Option A) must be performed by the RN; first doses of high-risk medications (Option B) require
RN assessment for allergic reactions; and discharge teaching for complex new diagnoses (Option D) requires
RN-level assessment and patient education skills. Delegating these would violate the Five Rights of Delegation.
Q5: A registered nurse delegates oral medication administration to a nursing assistant who has not been
trained or validated in medication administration. The patient receives the wrong medication and
experiences an adverse reaction. Under the legal principle of respondeat superior, who bears primary
liability?
A. The nursing assistant, for accepting a task outside their scope of practice.
NUR 106 Final Exam - Complete Solutions Page 2
,NUR 106 - Fundamentals of Nursing Final Examination 100 Questions with Complete Solutions
B. The registered nurse, for delegating a task to an unqualified individual. [CORRECT]
C. The pharmacy, for not labeling the medication correctly.
D. The patient, for not verifying the medication before taking it.
Correct Answer: B — The registered nurse, for delegating a task to an unqualified individual.
Rationale: The RN bears primary liability because delegation must follow the Five Rights of Delegation (right task,
right circumstances, right person, right direction/communication, right supervision/evaluation). Delegating
medication administration to an unlicensed assistive personnel without proper training violates the 'right person'
criterion, and the nurse remains accountable for the outcome. While the nursing assistant may share some
responsibility, the delegating RN holds the legal and professional accountability. Respondeat superior ('let the master
answer') holds the employer vicariously liable, but the RN's professional license is also at risk due to negligence in
delegation.
Q6: A 19-year-old patient is admitted to the emergency department following a motor vehicle accident.
The patient is unconscious and requires emergency surgery. The patient's parents are present and refuse
to consent to surgery, citing religious beliefs. What is the nurse's most appropriate action?
A. Honor the parents' refusal and document the refusal in the medical record.
B. Administer a sedative to calm the parents and proceed with surgical preparation.
C. Notify the healthcare provider and hospital ethics committee or risk management immediately,
as emergency treatment is generally permitted without consent when life is at risk. [CORRECT]
D. Contact the patient's sibling to obtain consent.
Correct Answer: C — Notify the healthcare provider and hospital ethics committee or risk management
immediately, as emergency treatment is generally permitted without consent when life is at risk.
Rationale: In emergency situations where a patient lacks decision-making capacity and life-threatening conditions
exist, the doctrine of implied consent permits healthcare providers to deliver life-saving treatment without formal
consent. The nurse should immediately notify the provider and hospital ethics committee/risk management to ensure
proper legal and ethical processes are followed. Options A and D could result in the patient's death from delays.
Option B is unethical and illegal. The Patient Self-Determination Act protects patient autonomy, but in true
emergencies with no advance directive available, preserving life supersedes surrogate refusal unless the patient
previously executed a valid advance directive refusing treatment.
Q7: A nurse administers 10 units of regular insulin subcutaneously instead of the prescribed 5 units. The
patient becomes hypoglycemic but recovers after IV dextrose is administered. The nurse immediately
reports the error, completes an incident report, and notifies the provider. Which statement best describes
this situation?
A. This is malpractice because harm occurred; the nurse will lose their license.
B. This is negligence because the nurse failed to meet the standard of care, and the incident report
supports quality improvement and legal documentation. [CORRECT]
C. This is an intentional tort requiring criminal prosecution.
D. This is assault because the patient was placed in fear of harm.
Correct Answer: B — This is negligence because the nurse failed to meet the standard of care, and the
incident report supports quality improvement and legal documentation.
Rationale: Negligence is the failure to exercise the degree of care that a reasonably prudent nurse would exercise
under similar circumstances, and administering the wrong dose violates the 'Right Dose' of medication
administration. The incident report serves dual purposes: it documents facts for quality improvement and provides
NUR 106 Final Exam - Complete Solutions Page 3
, NUR 106 - Fundamentals of Nursing Final Examination 100 Questions with Complete Solutions
legal protection if a claim arises. Malpractice requires four elements: duty, breach, causation, and damages—all
present here, but a single error does not automatically result in license revocation. The error was unintentional,
ruling out intentional torts and criminal prosecution. The nurse's prompt reporting demonstrates professional
accountability and supports a just culture approach to patient safety.
Q8: A nurse is caring for a patient whose family member requests detailed information about the
patient's diagnosis and treatment plan. The patient has not authorized information sharing with this
family member. Which action best demonstrates compliance with HIPAA regulations?
A. Share the information because the family member is involved in the patient's care.
B. Share only general information, such as the patient's room number and one-word condition update.
C. Explain that the patient's protected health information cannot be disclosed without
authorization, and encourage the family to speak directly with the patient. [CORRECT]
D. Refuse to speak with the family member at all and walk away.
Correct Answer: C — Explain that the patient's protected health information cannot be disclosed without
authorization, and encourage the family to speak directly with the patient.
Rationale: HIPAA's Privacy Rule requires patient authorization before disclosing Protected Health Information
(PHI) to family members not designated by the patient. Option C demonstrates therapeutic communication, patient
advocacy, and legal compliance by explaining the restriction respectfully and guiding the family to the appropriate
source (the patient). Option A violates HIPAA regardless of family involvement. Option B exceeds the 'minimum
necessary' standard for directory information and could constitute a breach. Option D, while not violating HIPAA, is
unprofessional and lacks therapeutic communication. The nurse should verify with the patient what information may
be shared and document the patient's preference in the medical record.
Q9: An elderly patient with terminal cancer refuses prescribed morphine, stating, 'I don't want to be a
burden to my family.' Which ethical principle is most directly supported by the nurse's action of
respecting this refusal after ensuring the patient understands the consequences?
A. Beneficence
B. Nonmaleficence
C. Autonomy [CORRECT]
D. Justice
Correct Answer: C — Autonomy
Rationale: Autonomy is the ethical principle that respects a competent patient's right to self-determination and
decision-making about their own care, even when those decisions may not align with the healthcare team's
recommendations. By ensuring the patient understands the consequences and then respecting the refusal, the nurse
honors autonomy while also upholding informed consent. Beneficence (acting in the patient's best interest) and
nonmaleficence (do no harm) would support administering pain relief, but they cannot override a competent patient's
autonomous decision. Justice refers to fairness and equitable distribution of resources, which is not directly relevant
to this scenario.
Q10: A nurse witnesses a colleague documenting vital signs that were not actually taken. The colleague
says, 'I'll just write down the values from the last shift, they were normal anyway.' What is the nurse's
most appropriate professional response?
A. Report the colleague to the state board of nursing immediately without speaking to them.
NUR 106 Final Exam - Complete Solutions Page 4
NUR 106 - Fundamentals of Nursing
Final Examination
100 Questions With Complete Solutions
Cognitive Distribution: 25% Recall / 50%
Total Questions: 100
Application / 25% Analysis
Question Style: 70% Scenario-based / 20%
Format: Multiple Choice (4 options, one correct)
Application / 10% Recall
Passing Standard: Fundamentals of Nursing
Aligned with ANA Standards of Nursing Practice
Competency
SECTION 1: Fundamentals of Nursing Practice (Q1-Q20)
Nursing Process (ADPIE), Documentation, Communication, Delegation, and Legal/Ethical Principles
Q1: A nurse is caring for a 68-year-old patient admitted with heart failure exacerbation. After assessing
the patient and identifying bilateral crackles, 2+ pitting edema, and a weight gain of 4 pounds in 24
hours, the nurse documents the findings and notifies the provider. Which step of the nursing process
(ADPIE) is the nurse demonstrating?
A. Assessment [CORRECT]
B. Diagnosis
C. Planning
D. Implementation
Correct Answer: A — Assessment
Rationale: The nurse is performing Assessment, the first step of ADPIE, which involves the systematic collection of
subjective and objective data through history-taking, physical examination, and review of diagnostic findings.
Although the nurse documents and communicates findings, the act of gathering assessment data (crackles, edema,
weight gain) is the defining activity. Diagnosis would involve formulating a NANDA-I label such as 'Fluid Volume
Overload,' Planning involves setting measurable outcomes, and Implementation involves executing nursing
interventions.
Q2: A new graduate nurse is developing a care plan for a postoperative patient. Which nursing diagnosis
is written in the correct format according to NANDA-I guidelines?
A. Acute Pain related to surgical incision as evidenced by patient stating pain is 8/10 and guarding
behavior. [CORRECT]
B. Acute Pain related to surgery.
C. Acute Pain 8/10 requiring analgesia.
D. Surgical Pain manifested by patient distress and need for pain medication.
Correct Answer: A — Acute Pain related to surgical incision as evidenced by patient stating pain is 8/10 and
guarding behavior.
NUR 106 Final Exam - Complete Solutions Page 1
,NUR 106 - Fundamentals of Nursing Final Examination 100 Questions with Complete Solutions
Rationale: A correctly written NANDA-I nursing diagnosis contains three components: the problem (diagnostic
label), the etiology (related to factor), and the defining characteristics (as evidenced by signs/symptoms). Option A
includes all three elements. Option B omits defining characteristics, making the diagnosis unverifiable. Option C is
not a recognized diagnostic format and lacks the etiological factor. Option D uses incorrect terminology ('manifested
by') and does not follow the PES (Problem-Etiology-Symptoms) structure that guides nursing interventions.
Q3: A nurse is documenting a patient's response to pain medication in the electronic health record.
Which documentation entry represents the most complete and legally sound example?
A. Pt states pain improved. Med given.
B. Pt reports pain decreased from 8/10 to 3/10 thirty minutes after administration of morphine 4 mg
IV. Resting quietly with HR 76, BP 118/72, RR 16. No adverse effects observed. [CORRECT]
C. Pain medication effective. Pt comfortable.
D. Morphine 4 mg IV administered for pain. Pt appears better.
Correct Answer: B — Pt reports pain decreased from 8/10 to 3/10 thirty minutes after administration of
morphine 4 mg IV. Resting quietly with HR 76, BP 118/72, RR 16. No adverse effects observed.
Rationale: Option B exemplifies complete nursing documentation by including the intervention (medication, dose,
route, time), subjective reassessment (pain score before and after), objective findings (vital signs), and patient
response. This documentation meets legal standards because it is factual, measurable, timely, and reflects the nursing
process. Options A, C, and D contain vague terms ('improved,' 'comfortable,' 'appears better') that are subjective,
non-measurable, and fail to demonstrate the effectiveness of the intervention. Such documentation would not defend
the nurse in a malpractice claim.
Q4: A charge nurse on a medical-surgical unit is planning assignments for the shift. Which task is most
appropriate to delegate to a licensed practical nurse (LPN)?
A. Initial admission assessment of a patient transferred from the emergency department with chest pain.
B. Administering the first dose of a newly ordered IV antibiotic to a patient with a history of anaphylaxis.
C. Monitoring vital signs and wound care for a stable postoperative patient whose condition is
uncomplicated. [CORRECT]
D. Developing the discharge teaching plan for a patient with newly diagnosed heart failure.
Correct Answer: C — Monitoring vital signs and wound care for a stable postoperative patient whose
condition is uncomplicated.
Rationale: The LPN's scope of practice includes caring for stable patients with predictable outcomes and performing
routine tasks such as vital sign monitoring and wound care. Option C fits this scope because the patient is stable with
an uncomplicated recovery. The other tasks require the RN's broader assessment, critical thinking, and judgment:
initial assessments (Option A) must be performed by the RN; first doses of high-risk medications (Option B) require
RN assessment for allergic reactions; and discharge teaching for complex new diagnoses (Option D) requires
RN-level assessment and patient education skills. Delegating these would violate the Five Rights of Delegation.
Q5: A registered nurse delegates oral medication administration to a nursing assistant who has not been
trained or validated in medication administration. The patient receives the wrong medication and
experiences an adverse reaction. Under the legal principle of respondeat superior, who bears primary
liability?
A. The nursing assistant, for accepting a task outside their scope of practice.
NUR 106 Final Exam - Complete Solutions Page 2
,NUR 106 - Fundamentals of Nursing Final Examination 100 Questions with Complete Solutions
B. The registered nurse, for delegating a task to an unqualified individual. [CORRECT]
C. The pharmacy, for not labeling the medication correctly.
D. The patient, for not verifying the medication before taking it.
Correct Answer: B — The registered nurse, for delegating a task to an unqualified individual.
Rationale: The RN bears primary liability because delegation must follow the Five Rights of Delegation (right task,
right circumstances, right person, right direction/communication, right supervision/evaluation). Delegating
medication administration to an unlicensed assistive personnel without proper training violates the 'right person'
criterion, and the nurse remains accountable for the outcome. While the nursing assistant may share some
responsibility, the delegating RN holds the legal and professional accountability. Respondeat superior ('let the master
answer') holds the employer vicariously liable, but the RN's professional license is also at risk due to negligence in
delegation.
Q6: A 19-year-old patient is admitted to the emergency department following a motor vehicle accident.
The patient is unconscious and requires emergency surgery. The patient's parents are present and refuse
to consent to surgery, citing religious beliefs. What is the nurse's most appropriate action?
A. Honor the parents' refusal and document the refusal in the medical record.
B. Administer a sedative to calm the parents and proceed with surgical preparation.
C. Notify the healthcare provider and hospital ethics committee or risk management immediately,
as emergency treatment is generally permitted without consent when life is at risk. [CORRECT]
D. Contact the patient's sibling to obtain consent.
Correct Answer: C — Notify the healthcare provider and hospital ethics committee or risk management
immediately, as emergency treatment is generally permitted without consent when life is at risk.
Rationale: In emergency situations where a patient lacks decision-making capacity and life-threatening conditions
exist, the doctrine of implied consent permits healthcare providers to deliver life-saving treatment without formal
consent. The nurse should immediately notify the provider and hospital ethics committee/risk management to ensure
proper legal and ethical processes are followed. Options A and D could result in the patient's death from delays.
Option B is unethical and illegal. The Patient Self-Determination Act protects patient autonomy, but in true
emergencies with no advance directive available, preserving life supersedes surrogate refusal unless the patient
previously executed a valid advance directive refusing treatment.
Q7: A nurse administers 10 units of regular insulin subcutaneously instead of the prescribed 5 units. The
patient becomes hypoglycemic but recovers after IV dextrose is administered. The nurse immediately
reports the error, completes an incident report, and notifies the provider. Which statement best describes
this situation?
A. This is malpractice because harm occurred; the nurse will lose their license.
B. This is negligence because the nurse failed to meet the standard of care, and the incident report
supports quality improvement and legal documentation. [CORRECT]
C. This is an intentional tort requiring criminal prosecution.
D. This is assault because the patient was placed in fear of harm.
Correct Answer: B — This is negligence because the nurse failed to meet the standard of care, and the
incident report supports quality improvement and legal documentation.
Rationale: Negligence is the failure to exercise the degree of care that a reasonably prudent nurse would exercise
under similar circumstances, and administering the wrong dose violates the 'Right Dose' of medication
administration. The incident report serves dual purposes: it documents facts for quality improvement and provides
NUR 106 Final Exam - Complete Solutions Page 3
, NUR 106 - Fundamentals of Nursing Final Examination 100 Questions with Complete Solutions
legal protection if a claim arises. Malpractice requires four elements: duty, breach, causation, and damages—all
present here, but a single error does not automatically result in license revocation. The error was unintentional,
ruling out intentional torts and criminal prosecution. The nurse's prompt reporting demonstrates professional
accountability and supports a just culture approach to patient safety.
Q8: A nurse is caring for a patient whose family member requests detailed information about the
patient's diagnosis and treatment plan. The patient has not authorized information sharing with this
family member. Which action best demonstrates compliance with HIPAA regulations?
A. Share the information because the family member is involved in the patient's care.
B. Share only general information, such as the patient's room number and one-word condition update.
C. Explain that the patient's protected health information cannot be disclosed without
authorization, and encourage the family to speak directly with the patient. [CORRECT]
D. Refuse to speak with the family member at all and walk away.
Correct Answer: C — Explain that the patient's protected health information cannot be disclosed without
authorization, and encourage the family to speak directly with the patient.
Rationale: HIPAA's Privacy Rule requires patient authorization before disclosing Protected Health Information
(PHI) to family members not designated by the patient. Option C demonstrates therapeutic communication, patient
advocacy, and legal compliance by explaining the restriction respectfully and guiding the family to the appropriate
source (the patient). Option A violates HIPAA regardless of family involvement. Option B exceeds the 'minimum
necessary' standard for directory information and could constitute a breach. Option D, while not violating HIPAA, is
unprofessional and lacks therapeutic communication. The nurse should verify with the patient what information may
be shared and document the patient's preference in the medical record.
Q9: An elderly patient with terminal cancer refuses prescribed morphine, stating, 'I don't want to be a
burden to my family.' Which ethical principle is most directly supported by the nurse's action of
respecting this refusal after ensuring the patient understands the consequences?
A. Beneficence
B. Nonmaleficence
C. Autonomy [CORRECT]
D. Justice
Correct Answer: C — Autonomy
Rationale: Autonomy is the ethical principle that respects a competent patient's right to self-determination and
decision-making about their own care, even when those decisions may not align with the healthcare team's
recommendations. By ensuring the patient understands the consequences and then respecting the refusal, the nurse
honors autonomy while also upholding informed consent. Beneficence (acting in the patient's best interest) and
nonmaleficence (do no harm) would support administering pain relief, but they cannot override a competent patient's
autonomous decision. Justice refers to fairness and equitable distribution of resources, which is not directly relevant
to this scenario.
Q10: A nurse witnesses a colleague documenting vital signs that were not actually taken. The colleague
says, 'I'll just write down the values from the last shift, they were normal anyway.' What is the nurse's
most appropriate professional response?
A. Report the colleague to the state board of nursing immediately without speaking to them.
NUR 106 Final Exam - Complete Solutions Page 4
