NR 224 Exam 1: Fundamentals of Nursing — Summer 2026/2027
NR 224 EXAM 1: THE REAL TEST RESULTS
(SUMMER 2026/2027) — FUNDAMENTALS OF NURSING COMPREHENSIVE EXAMINATION
Aligned with: NR 224 Course Syllabus • ATI Fundamentals of Nursing Content Mastery Series • NCLEX-RN Test Plan •
Evidence-Based Nursing Practice Standards (2026/2027 Edition)
100 Questions • Cognitive distribution: 20% recall / 50% application / 30% analysis • 75% scenario-based, 25% direct
knowledge • Suggested time: 150 minutes
Special inclusions: 10 priority-setting questions • 10 medication administration and dosage calculation questions • 10 health
assessment and vital signs interpretation questions
Section 1: Nursing Process & Critical Thinking
Q1: A nurse is caring for a 68-year-old patient admitted with heart failure exacerbation. After completing the
admission assessment, the nurse identifies decreased activity tolerance, bilateral crackles, and 2+ pitting edema.
Which step of the nursing process should the nurse implement NEXT?
A. Reassess the patient in 2 hours to determine if findings have changed.
B. Formulate nursing diagnoses based on the assessment data collected. [CORRECT]
C. Implement interventions such as elevating the legs and administering furosemide.
D. Evaluate the effectiveness of the current medical treatment plan.
Correct Answer: B
Rationale:
The nursing process follows the sequential ADPIE framework: Assessment, Diagnosis, Planning, Implementation,
Evaluation. After completing the assessment phase, the nurse must analyze data and formulate nursing diagnoses
before establishing goals and interventions. NR 224 curriculum emphasizes that skipping the diagnostic phase leads to
unfocused, unsafe care plans that fail to address the patient's actual problems.
Q2: Which of the following is a correctly written NANDA-I nursing diagnosis that follows the three-part (PES)
format?
A. Acute Pain related to surgical incision as evidenced by patient rating pain 8/10 and grimacing. [CORRECT]
B. Impaired Mobility due to physician's orders for bed rest.
C. Risk for Infection related to compromised immune system.
D. Anxiety manifested by nervous behavior.
Correct Answer: A
Rationale:
The PES format consists of Problem (P), Etiology (E - 'related to'), and Signs/Symptoms (S - 'as evidenced by'). Option
A includes all three components correctly. Option B uses 'due to' (medical diagnosis framing) instead of 'related to'.
Option C is a risk diagnosis, which lacks defining characteristics because the problem has not yet occurred. Option D
omits the etiology ('related to') component entirely.
NR 224 Fundamentals Examination | Page 1
,NR 224 Exam 1: Fundamentals of Nursing — Summer 2026/2027
Q3: A nurse on a medical-surgical unit is assigned to four patients. Using Maslow's hierarchy of needs, which patient
should the nurse prioritize for assessment FIRST?
A. A patient requesting pain medication for chronic low back pain rated 4/10.
B. A patient with new-onset shortness of breath and an SpO2 of 88% on room air. [CORRECT]
C. A patient who is upset because family members have not visited today.
D. A patient scheduled for discharge teaching regarding wound care.
Correct Answer: B
Rationale:
Maslow's hierarchy prioritizes physiological needs (oxygenation, circulation) above safety, love/belonging, esteem,
and self-actualization needs. The patient with SpO2 88% and dyspnea has an unmet physiological need requiring
immediate intervention to prevent respiratory failure. NR 224 curriculum and NCLEX-RN Test Plan (Management of
Care) require the nurse to use the airway-breathing-circulation (ABC) framework as the first priority in clinical
decision-making.
Q4: A nurse is writing a goal for a patient with a nursing diagnosis of Impaired Skin Integrity. Which goal is
correctly written and meets SMART criteria?
A. Patient's wound will heal quickly during hospitalization.
B. Patient will have improved skin integrity within a reasonable timeframe.
C. Patient's stage II sacral pressure ulcer will demonstrate granulation tissue within 14 days of admission.
[CORRECT]
D. Patient will not develop further skin breakdown.
Correct Answer: C
Rationale:
SMART goals are Specific, Measurable, Achievable, Realistic, and Time-bound. Option C specifies the exact outcome
(granulation tissue), the location (sacral pressure ulcer), the staging (stage II), and the timeframe (14 days). Options A,
B, and D lack measurable outcomes, specific criteria, or defined timeframes, making evaluation of progress
impossible.
Q5: At 07:00, a nurse receives handoff report on four patients. Which patient should the nurse assess FIRST?
A. A 72-year-old postoperative hip replacement patient who received morphine 4 mg IV at 06:45 for incisional pain.
[CORRECT]
B. A 54-year-old with heart failure whose weight increased by 1.5 kg overnight and has 2+ pitting edema.
C. A 45-year-old with pneumonia whose morning temperature is 38.3°C (101°F) and is scheduled for antibiotics at
08:00.
D. A 60-year-old newly admitted patient with type 2 diabetes and a fasting blood glucose of 9.4 mmol/L (170
mg/dL).
Correct Answer: A
Rationale:
The patient who received IV morphine 15 minutes ago is at highest risk for opioid-induced respiratory depression, the
most life-threatening condition among the four. Per NCLEX prioritization and the ABC framework, the nurse must
assess respiratory rate, depth, SpO2, and sedation level before the morphine reaches peak effect (approximately 20
minutes). The other patients require timely intervention but are not in immediate physiological jeopardy.
NR 224 Fundamentals Examination | Page 2
,NR 224 Exam 1: Fundamentals of Nursing — Summer 2026/2027
Q6: During the evaluation phase of the nursing process, the nurse determines that a patient's goal of 'ambulating 50
feet with a walker by postoperative day 3' has not been met. What is the most appropriate nursing action?
A. Discontinue the goal because the patient is noncompliant.
B. Reassess the patient, identify barriers, and revise the care plan accordingly. [CORRECT]
C. Increase the goal distance to motivate the patient to work harder.
D. Document that the goal was unrealistic and notify the healthcare provider.
Correct Answer: B
Rationale:
Evaluation is the final step of the nursing process but is also cyclical, leading back to reassessment and care plan
revision. When goals are not met, the nurse must reassess the patient, identify barriers (pain, weakness, fear,
inadequate analgesia), and revise the plan with new interventions or modified goals. Discontinuing or escalating goals
without assessment violates the nursing process and EBP standards.
Q7: Which of the following best demonstrates the use of clinical judgment in nursing practice?
A. Following the healthcare provider's orders exactly as written without question.
B. Recognizing that a patient's declining urine output may indicate fluid volume deficit and promptly notifying the
provider. [CORRECT]
C. Administering all scheduled medications at the same time to save nursing time.
D. Documenting care after completing the entire shift to avoid interruption.
Correct Answer: B
Rationale:
Clinical judgment involves noticing, interpreting, responding, and reflecting on patient data. The nurse who identifies
the significance of declining urine output and anticipates a potential complication demonstrates analysis and clinical
reasoning, key components of Tanner's Clinical Judgment Model. The other options reflect task-oriented thinking,
which NR 224 identifies as a barrier to safe, patient-centered care.
Q8: A nurse is implementing evidence-based practice (EBP) for pressure ulcer prevention. Which combination
correctly represents the three components of EBP?
A. Patient preferences, clinical expertise, and research evidence. [CORRECT]
B. Healthcare provider orders, nursing textbooks, and patient requests.
C. Clinical pathways, hospital policies, and insurance guidelines.
D. Nursing theory, medical diagnosis, and pharmaceutical research.
Correct Answer: A
Rationale:
Evidence-based practice integrates the best available research evidence with the nurse's clinical expertise and the
patient's individual values and preferences. NR 224 emphasizes that EBP is the foundation of safe, quality nursing care
and is mandated by the ANA Standards of Practice. The other options omit one or more critical components, leading to
care that is not patient-centered or evidence-informed.
NR 224 Fundamentals Examination | Page 3
, NR 224 Exam 1: Fundamentals of Nursing — Summer 2026/2027
Q9: A nurse manager wants to implement a quality improvement project to reduce catheter-associated urinary tract
infections (CAUTI) on the unit. Which quality improvement methodology uses the cyclic steps of
Plan-Do-Study-Act?
A. Six Sigma DMAIC process.
B. Root cause analysis (RCA) framework.
C. PDSA cycle developed by W. Edwards Deming. [CORRECT]
D. Failure Mode and Effects Analysis (FMEA).
Correct Answer: C
Rationale:
The PDSA (Plan-Do-Study-Act) cycle, also known as the Deming cycle, is a systematic, iterative four-step quality
improvement methodology used to test and implement changes in clinical practice. NR 224 quality improvement
content identifies PDSA as the foundational framework for unit-based QI projects. The other methodologies are valid
QI tools but do not use the PDSA sequence.
Q10: Which of the following is an example of a nursing-sensitive indicator as defined by the National Database of
Nursing Quality Indicators (NDNQI)?
A. Hospital readmission rates within 30 days of discharge.
B. Patient falls per 1,000 patient-days on a nursing unit. [CORRECT]
C. Surgical site infection rates following elective surgery.
D. Average length of stay for patients with pneumonia.
Correct Answer: B
Rationale:
Nursing-sensitive indicators are outcomes that are directly influenced by nursing care and include patient falls,
pressure ulcers, catheter-associated infections, and nurse satisfaction. Fall rates per 1,000 patient-days are a core
NDNQI measure reflecting the quality of nursing interventions related to mobility, assessment, and safety. The other
options are hospital-level or system-level indicators not directly attributable to nursing care.
Q11: A nurse is conducting a comprehensive admission assessment. Which of the following findings should be
documented as SUBJECTIVE data?
A. Patient's blood pressure is 148/92 mmHg with the patient supine.
B. Patient states, 'I feel dizzy when I stand up quickly in the morning.' [CORRECT]
C. Bilateral breath sounds reveal crackles in the lower lobes.
D. The surgical incision is well-approximated without drainage.
Correct Answer: B
Rationale:
Subjective data are information provided verbally by the patient, often described as 'symptoms' or what the patient
reports feeling. Objective data are observable, measurable findings collected by the nurse through inspection,
palpation, percussion, and auscultation. Option B is the only statement that is the patient's verbal report, which NR 224
identifies as a critical component of the assessment phase.
NR 224 Fundamentals Examination | Page 4
NR 224 EXAM 1: THE REAL TEST RESULTS
(SUMMER 2026/2027) — FUNDAMENTALS OF NURSING COMPREHENSIVE EXAMINATION
Aligned with: NR 224 Course Syllabus • ATI Fundamentals of Nursing Content Mastery Series • NCLEX-RN Test Plan •
Evidence-Based Nursing Practice Standards (2026/2027 Edition)
100 Questions • Cognitive distribution: 20% recall / 50% application / 30% analysis • 75% scenario-based, 25% direct
knowledge • Suggested time: 150 minutes
Special inclusions: 10 priority-setting questions • 10 medication administration and dosage calculation questions • 10 health
assessment and vital signs interpretation questions
Section 1: Nursing Process & Critical Thinking
Q1: A nurse is caring for a 68-year-old patient admitted with heart failure exacerbation. After completing the
admission assessment, the nurse identifies decreased activity tolerance, bilateral crackles, and 2+ pitting edema.
Which step of the nursing process should the nurse implement NEXT?
A. Reassess the patient in 2 hours to determine if findings have changed.
B. Formulate nursing diagnoses based on the assessment data collected. [CORRECT]
C. Implement interventions such as elevating the legs and administering furosemide.
D. Evaluate the effectiveness of the current medical treatment plan.
Correct Answer: B
Rationale:
The nursing process follows the sequential ADPIE framework: Assessment, Diagnosis, Planning, Implementation,
Evaluation. After completing the assessment phase, the nurse must analyze data and formulate nursing diagnoses
before establishing goals and interventions. NR 224 curriculum emphasizes that skipping the diagnostic phase leads to
unfocused, unsafe care plans that fail to address the patient's actual problems.
Q2: Which of the following is a correctly written NANDA-I nursing diagnosis that follows the three-part (PES)
format?
A. Acute Pain related to surgical incision as evidenced by patient rating pain 8/10 and grimacing. [CORRECT]
B. Impaired Mobility due to physician's orders for bed rest.
C. Risk for Infection related to compromised immune system.
D. Anxiety manifested by nervous behavior.
Correct Answer: A
Rationale:
The PES format consists of Problem (P), Etiology (E - 'related to'), and Signs/Symptoms (S - 'as evidenced by'). Option
A includes all three components correctly. Option B uses 'due to' (medical diagnosis framing) instead of 'related to'.
Option C is a risk diagnosis, which lacks defining characteristics because the problem has not yet occurred. Option D
omits the etiology ('related to') component entirely.
NR 224 Fundamentals Examination | Page 1
,NR 224 Exam 1: Fundamentals of Nursing — Summer 2026/2027
Q3: A nurse on a medical-surgical unit is assigned to four patients. Using Maslow's hierarchy of needs, which patient
should the nurse prioritize for assessment FIRST?
A. A patient requesting pain medication for chronic low back pain rated 4/10.
B. A patient with new-onset shortness of breath and an SpO2 of 88% on room air. [CORRECT]
C. A patient who is upset because family members have not visited today.
D. A patient scheduled for discharge teaching regarding wound care.
Correct Answer: B
Rationale:
Maslow's hierarchy prioritizes physiological needs (oxygenation, circulation) above safety, love/belonging, esteem,
and self-actualization needs. The patient with SpO2 88% and dyspnea has an unmet physiological need requiring
immediate intervention to prevent respiratory failure. NR 224 curriculum and NCLEX-RN Test Plan (Management of
Care) require the nurse to use the airway-breathing-circulation (ABC) framework as the first priority in clinical
decision-making.
Q4: A nurse is writing a goal for a patient with a nursing diagnosis of Impaired Skin Integrity. Which goal is
correctly written and meets SMART criteria?
A. Patient's wound will heal quickly during hospitalization.
B. Patient will have improved skin integrity within a reasonable timeframe.
C. Patient's stage II sacral pressure ulcer will demonstrate granulation tissue within 14 days of admission.
[CORRECT]
D. Patient will not develop further skin breakdown.
Correct Answer: C
Rationale:
SMART goals are Specific, Measurable, Achievable, Realistic, and Time-bound. Option C specifies the exact outcome
(granulation tissue), the location (sacral pressure ulcer), the staging (stage II), and the timeframe (14 days). Options A,
B, and D lack measurable outcomes, specific criteria, or defined timeframes, making evaluation of progress
impossible.
Q5: At 07:00, a nurse receives handoff report on four patients. Which patient should the nurse assess FIRST?
A. A 72-year-old postoperative hip replacement patient who received morphine 4 mg IV at 06:45 for incisional pain.
[CORRECT]
B. A 54-year-old with heart failure whose weight increased by 1.5 kg overnight and has 2+ pitting edema.
C. A 45-year-old with pneumonia whose morning temperature is 38.3°C (101°F) and is scheduled for antibiotics at
08:00.
D. A 60-year-old newly admitted patient with type 2 diabetes and a fasting blood glucose of 9.4 mmol/L (170
mg/dL).
Correct Answer: A
Rationale:
The patient who received IV morphine 15 minutes ago is at highest risk for opioid-induced respiratory depression, the
most life-threatening condition among the four. Per NCLEX prioritization and the ABC framework, the nurse must
assess respiratory rate, depth, SpO2, and sedation level before the morphine reaches peak effect (approximately 20
minutes). The other patients require timely intervention but are not in immediate physiological jeopardy.
NR 224 Fundamentals Examination | Page 2
,NR 224 Exam 1: Fundamentals of Nursing — Summer 2026/2027
Q6: During the evaluation phase of the nursing process, the nurse determines that a patient's goal of 'ambulating 50
feet with a walker by postoperative day 3' has not been met. What is the most appropriate nursing action?
A. Discontinue the goal because the patient is noncompliant.
B. Reassess the patient, identify barriers, and revise the care plan accordingly. [CORRECT]
C. Increase the goal distance to motivate the patient to work harder.
D. Document that the goal was unrealistic and notify the healthcare provider.
Correct Answer: B
Rationale:
Evaluation is the final step of the nursing process but is also cyclical, leading back to reassessment and care plan
revision. When goals are not met, the nurse must reassess the patient, identify barriers (pain, weakness, fear,
inadequate analgesia), and revise the plan with new interventions or modified goals. Discontinuing or escalating goals
without assessment violates the nursing process and EBP standards.
Q7: Which of the following best demonstrates the use of clinical judgment in nursing practice?
A. Following the healthcare provider's orders exactly as written without question.
B. Recognizing that a patient's declining urine output may indicate fluid volume deficit and promptly notifying the
provider. [CORRECT]
C. Administering all scheduled medications at the same time to save nursing time.
D. Documenting care after completing the entire shift to avoid interruption.
Correct Answer: B
Rationale:
Clinical judgment involves noticing, interpreting, responding, and reflecting on patient data. The nurse who identifies
the significance of declining urine output and anticipates a potential complication demonstrates analysis and clinical
reasoning, key components of Tanner's Clinical Judgment Model. The other options reflect task-oriented thinking,
which NR 224 identifies as a barrier to safe, patient-centered care.
Q8: A nurse is implementing evidence-based practice (EBP) for pressure ulcer prevention. Which combination
correctly represents the three components of EBP?
A. Patient preferences, clinical expertise, and research evidence. [CORRECT]
B. Healthcare provider orders, nursing textbooks, and patient requests.
C. Clinical pathways, hospital policies, and insurance guidelines.
D. Nursing theory, medical diagnosis, and pharmaceutical research.
Correct Answer: A
Rationale:
Evidence-based practice integrates the best available research evidence with the nurse's clinical expertise and the
patient's individual values and preferences. NR 224 emphasizes that EBP is the foundation of safe, quality nursing care
and is mandated by the ANA Standards of Practice. The other options omit one or more critical components, leading to
care that is not patient-centered or evidence-informed.
NR 224 Fundamentals Examination | Page 3
, NR 224 Exam 1: Fundamentals of Nursing — Summer 2026/2027
Q9: A nurse manager wants to implement a quality improvement project to reduce catheter-associated urinary tract
infections (CAUTI) on the unit. Which quality improvement methodology uses the cyclic steps of
Plan-Do-Study-Act?
A. Six Sigma DMAIC process.
B. Root cause analysis (RCA) framework.
C. PDSA cycle developed by W. Edwards Deming. [CORRECT]
D. Failure Mode and Effects Analysis (FMEA).
Correct Answer: C
Rationale:
The PDSA (Plan-Do-Study-Act) cycle, also known as the Deming cycle, is a systematic, iterative four-step quality
improvement methodology used to test and implement changes in clinical practice. NR 224 quality improvement
content identifies PDSA as the foundational framework for unit-based QI projects. The other methodologies are valid
QI tools but do not use the PDSA sequence.
Q10: Which of the following is an example of a nursing-sensitive indicator as defined by the National Database of
Nursing Quality Indicators (NDNQI)?
A. Hospital readmission rates within 30 days of discharge.
B. Patient falls per 1,000 patient-days on a nursing unit. [CORRECT]
C. Surgical site infection rates following elective surgery.
D. Average length of stay for patients with pneumonia.
Correct Answer: B
Rationale:
Nursing-sensitive indicators are outcomes that are directly influenced by nursing care and include patient falls,
pressure ulcers, catheter-associated infections, and nurse satisfaction. Fall rates per 1,000 patient-days are a core
NDNQI measure reflecting the quality of nursing interventions related to mobility, assessment, and safety. The other
options are hospital-level or system-level indicators not directly attributable to nursing care.
Q11: A nurse is conducting a comprehensive admission assessment. Which of the following findings should be
documented as SUBJECTIVE data?
A. Patient's blood pressure is 148/92 mmHg with the patient supine.
B. Patient states, 'I feel dizzy when I stand up quickly in the morning.' [CORRECT]
C. Bilateral breath sounds reveal crackles in the lower lobes.
D. The surgical incision is well-approximated without drainage.
Correct Answer: B
Rationale:
Subjective data are information provided verbally by the patient, often described as 'symptoms' or what the patient
reports feeling. Objective data are observable, measurable findings collected by the nurse through inspection,
palpation, percussion, and auscultation. Option B is the only statement that is the patient's verbal report, which NR 224
identifies as a critical component of the assessment phase.
NR 224 Fundamentals Examination | Page 4
