NURS-FPX 4000 Exam 2025 – Developing a Nursing
Perspective | 70 REAL EXAM Questions & Answers
(FULL & Verified)
Medical-Surgical (7)
1. A 68-year-old with CHF presents with increasing dyspnea and 3+ pitting
edema. Which nursing action is highest priority?
A. Encourage high-protein diet
B. Weigh patient daily and report a 2-lb gain
C. Elevate legs and provide TED hose
D. Administer PRN opioid for anxiety
Answer-: B. Daily weights detect fluid retention early and guide diuretic
therapy; highest priority for acute CHF management.
2. A post-op patient has a sudden drop in BP, tachycardia, and cool, clammy
skin 12 hours after surgery. First action?
A. Call provider for fluids
B. Check surgical site for bleeding and dressing
C. Administer PRN analgesic
D. Get a 12-lead ECG
Answer-: B. Post-op hypotension/tachycardia can indicate bleeding—assess
surgical site immediately.
3. A patient with type 2 diabetes on metformin reports new-onset fatigue and
abdominal pain; vitals stable. Which lab is most urgent to check?
A. Hemoglobin A1c
B. Serum creatinine
C. Serum sodium
D. TSH
, Answer-: B. Metformin contraindications include renal impairment; check
creatinine to avoid lactic acidosis risk.
4. On assessment a patient has diminished left radial pulse and pale, painful
left hand after a cast was applied. Nurse should:
A. Elevate limb and observe
B. Loosen cast and notify provider immediately
C. Apply warm compresses
D. Document findings and recheck in 2 hours
Answer-: B. Signs of compartment syndrome or neurovascular compromise
require immediate release and provider notification.
5. A patient on heparin infusion has an unexpected drop in platelet count
from 250k to 80k over 5 days. Nurse should:
A. Continue heparin and recheck in 24 hr
B. Stop heparin and notify provider — evaluate for HIT
C. Increase heparin rate to achieve target aPTT
D. Give platelet transfusion immediately
Answer-: B. A drop >50% suggests heparin-induced thrombocytopenia; stop
heparin and notify provider.
6. Which finding suggests ineffective pain relief after analgesic dose?
A. Pain score decreased 2 points lasting 4 hours
B. Patient reports pain 6/10 with guarding despite analgesic 30 min ago
C. Patient sleeping quietly after dose
D. Vital signs unchanged from baseline
Answer-: B. Persistent moderate pain with guarding suggests inadequate
analgesia and needs reassessment.
7. A patient with acute pancreatitis has hypocalcemia signs (perioral tingling).
Which order should nurse anticipate?
A. IV calcium gluconate and continuous monitoring
B. Administer oral calcium tablets immediately
C. Restrict fluids and start TPN
D. Give IV magnesium sulfate
Answer-: A. Symptomatic hypocalcemia in acute illness may require IV
calcium and monitoring.
, Critical Care / Acute Care (7)
8. A mechanically ventilated patient with ARDS has rising peak airway
pressures and sudden oxygen desaturation. First action:
A. Increase FiO₂ immediately
B. Check for ventilator tubing disconnect, tube position, and breath sounds
C. Give sedative bolus
D. Start chest physiotherapy
Answer-: B. Sudden changes may be due to tube obstruction, kinking, or
pneumothorax—assess equipment and patient first.
9. A patient in ICU on norepinephrine via peripheral IV suddenly has blanching
and pain at the site. Nurse should:
A. Apply warm compress over area
B. Stop infusion, aspirate drug from line, leave catheter in place, notify
provider
C. Increase infusion rate to improve perfusion
D. Flush with normal saline and continue
Answer-: B. Vasopressor extravasation needs immediate attention—stop
infusion, aspirate, leave catheter for antidote administration.
10.A patient with sepsis has MAP 58 mmHg despite fluids. Best next step?
A. Start vasopressor (norepinephrine) per protocol
B. Give an additional bolus of antibiotics
C. Keep giving isotonic fluids only
D. Start high-dose steroids immediately
Answer-: A. MAP <65 despite adequate fluids indicates need for
vasopressors to maintain perfusion.
11.ICP monitoring shows sustained pressure of 24 mmHg. Nurse should:
A. Lower head of bed to 0°
B. Ensure head midline, HOB 30°, reduce stimulation, notify provider
C. Give hypotonic fluids
D. Encourage coughing and deep breathing
Answer-: B. ICP >20 requires interventions to lower pressure: HOB
elevation, midline head, reduce stimuli.
Perspective | 70 REAL EXAM Questions & Answers
(FULL & Verified)
Medical-Surgical (7)
1. A 68-year-old with CHF presents with increasing dyspnea and 3+ pitting
edema. Which nursing action is highest priority?
A. Encourage high-protein diet
B. Weigh patient daily and report a 2-lb gain
C. Elevate legs and provide TED hose
D. Administer PRN opioid for anxiety
Answer-: B. Daily weights detect fluid retention early and guide diuretic
therapy; highest priority for acute CHF management.
2. A post-op patient has a sudden drop in BP, tachycardia, and cool, clammy
skin 12 hours after surgery. First action?
A. Call provider for fluids
B. Check surgical site for bleeding and dressing
C. Administer PRN analgesic
D. Get a 12-lead ECG
Answer-: B. Post-op hypotension/tachycardia can indicate bleeding—assess
surgical site immediately.
3. A patient with type 2 diabetes on metformin reports new-onset fatigue and
abdominal pain; vitals stable. Which lab is most urgent to check?
A. Hemoglobin A1c
B. Serum creatinine
C. Serum sodium
D. TSH
, Answer-: B. Metformin contraindications include renal impairment; check
creatinine to avoid lactic acidosis risk.
4. On assessment a patient has diminished left radial pulse and pale, painful
left hand after a cast was applied. Nurse should:
A. Elevate limb and observe
B. Loosen cast and notify provider immediately
C. Apply warm compresses
D. Document findings and recheck in 2 hours
Answer-: B. Signs of compartment syndrome or neurovascular compromise
require immediate release and provider notification.
5. A patient on heparin infusion has an unexpected drop in platelet count
from 250k to 80k over 5 days. Nurse should:
A. Continue heparin and recheck in 24 hr
B. Stop heparin and notify provider — evaluate for HIT
C. Increase heparin rate to achieve target aPTT
D. Give platelet transfusion immediately
Answer-: B. A drop >50% suggests heparin-induced thrombocytopenia; stop
heparin and notify provider.
6. Which finding suggests ineffective pain relief after analgesic dose?
A. Pain score decreased 2 points lasting 4 hours
B. Patient reports pain 6/10 with guarding despite analgesic 30 min ago
C. Patient sleeping quietly after dose
D. Vital signs unchanged from baseline
Answer-: B. Persistent moderate pain with guarding suggests inadequate
analgesia and needs reassessment.
7. A patient with acute pancreatitis has hypocalcemia signs (perioral tingling).
Which order should nurse anticipate?
A. IV calcium gluconate and continuous monitoring
B. Administer oral calcium tablets immediately
C. Restrict fluids and start TPN
D. Give IV magnesium sulfate
Answer-: A. Symptomatic hypocalcemia in acute illness may require IV
calcium and monitoring.
, Critical Care / Acute Care (7)
8. A mechanically ventilated patient with ARDS has rising peak airway
pressures and sudden oxygen desaturation. First action:
A. Increase FiO₂ immediately
B. Check for ventilator tubing disconnect, tube position, and breath sounds
C. Give sedative bolus
D. Start chest physiotherapy
Answer-: B. Sudden changes may be due to tube obstruction, kinking, or
pneumothorax—assess equipment and patient first.
9. A patient in ICU on norepinephrine via peripheral IV suddenly has blanching
and pain at the site. Nurse should:
A. Apply warm compress over area
B. Stop infusion, aspirate drug from line, leave catheter in place, notify
provider
C. Increase infusion rate to improve perfusion
D. Flush with normal saline and continue
Answer-: B. Vasopressor extravasation needs immediate attention—stop
infusion, aspirate, leave catheter for antidote administration.
10.A patient with sepsis has MAP 58 mmHg despite fluids. Best next step?
A. Start vasopressor (norepinephrine) per protocol
B. Give an additional bolus of antibiotics
C. Keep giving isotonic fluids only
D. Start high-dose steroids immediately
Answer-: A. MAP <65 despite adequate fluids indicates need for
vasopressors to maintain perfusion.
11.ICP monitoring shows sustained pressure of 24 mmHg. Nurse should:
A. Lower head of bed to 0°
B. Ensure head midline, HOB 30°, reduce stimulation, notify provider
C. Give hypotonic fluids
D. Encourage coughing and deep breathing
Answer-: B. ICP >20 requires interventions to lower pressure: HOB
elevation, midline head, reduce stimuli.
