Chamberlain University NR224 Fundamentals
Exam Questions And Well Graded Solutions
With Rationales Updated 2026-2027
Master your Chamberlain University NR224 Fundamentals Skills Exam with this comprehensive study
guide. Features highly detailed multiple-choice questions complete with underlined correct
answers and comprehensive, evidence-based rationales. Covers critical Week 3 and Week 5
milestones, including infection control, immobility complications, sterile catheter insertion,
oxygenation, and nursing delegation rules. Perfect for acing your lecture exams and clinical check-
off
1. A nurse is caring for an immobile patient. Which physiological change should the
nurse monitor for as a direct result of immobility?
A. Increased cardiac output
B. Decreased risk of urinary tract infections
C. Increased bone density
D. Calcium resorption from bones into the bloodstream
Rationale: Immobility leads to the breakdown of bone matrix, causing calcium to
leave the bones and enter the blood (resorption). This leads to osteoporosis and
hypercalcemia. Cardiac output actually decreases over time, urinary stasis increases
infection risks, and bone density decreases.
2. A patient is on prolonged bed rest. Which nursing intervention is most effective in
preventing deep vein thrombosis (DVT)?
A. Massaging the patient's calves daily
B. Applying sequential compression devices (SCDs) as ordered
C. Restricting fluid intake to 1 liter per day
D. Keeping the patient's knees flexed with a pillow
Rationale: Sequential compression devices (SCDs) promote venous return and
prevent venous stasis, which is the primary cause of DVT in immobile patients.
Massaging calves can dislodge an existing clot. Restricting fluids thickens blood, and
flexing knees restricts venous blood flow.
3. The nurse note a patient's surgical wound has a thick, yellow-green drainage. How
should the nurse document this finding?
A. Serous exudate
B. Sanguineous drainage
C. Purulent exudate
D. Serosanguineous drainage
Rationale: Purulent drainage is thick, malodorous, and varies in color (green, yellow,
or brown), indicating an active bacterial infection. Serous is clear/watery,
sanguineous is bright red blood, and serosanguineous is pink and watery.
4. A nurse is preparing to perform a sterile procedure. Which action breaks the
principles of surgical asepsis?
A. Keeping the sterile field above waist level
B. Turning the back toward the sterile field to grab a trash can
C. Opening the outermost flap of a sterile kit away from the body
D. Maintaining a 1-inch border around the edge as contaminated
Rationale: Turning your back on a sterile field breaks the principle of visual
monitoring; any field out of direct line of sight is considered contaminated. All other
options describe correct aseptic techniques.
1|Page
,5. A nurse prepares to administer a medication. The patient states, "This pill looks
different than the one I usually take at home." What is the nurse's priority action?
A. Reassure the patient that the hospital uses a different generic brand
B. Withhold the medication and re-verify the order in the electronic chart
C. Administer the medication and document the patient's concern
D. Ask the patient's family member to identify the pill
Rationale: Whenever a patient questions a medication, the nurse must halt
administration, re-verify the prescription, and check for pharmacy dispensing errors
to ensure patient safety. Never assume it is just a brand difference without checking.
6. A nurse is checking a patient's capillary refill time and notes it takes 4 seconds. How
should the nurse interpret this finding?
A. Normal peripheral tissue perfusion
B. Sluggish peripheral perfusion requiring further clinical evaluation
C. Adequate core body temperature
D. An expected physiological response to pain
Rationale: Normal capillary refill is less than 2 seconds. A refill time of 4 seconds
indicates delayed or sluggish peripheral perfusion, which may point to dehydration,
peripheral vascular disease, or low cardiac output.
7. A nurse is teaching a patient how to use an incentive spirometer. Which instruction is
correct?
A. Exhale forcefully and quickly into the mouthpiece
B. Inhale slowly and deeply through the mouthpiece to raise the indicator
C. Use the device once every shift while awake
D. Hold your breath for 30 seconds after inhaling
Rationale: An incentive spirometer requires slow, deep inhalations to maximize lung
expansion and prevent atelectasis. It should be used roughly 10 times every hour
while awake, holding the breath for 3 to 5 seconds at peak inhalation.
8. Which action should the nurse take first when a patient's tracheostomy tube
accidentally becomes dislodged?
A. Call the healthcare provider immediately from the nurses' station
B. Attempt to gently reinsert the tracheostomy tube using the obturator if
available
C. Cover the stoma completely with an occlusive dressing
D. Administer high-flow oxygen via a nasal cannula over the nose
Rationale: The immediate nursing priority is maintaining a patent airway. The nurse
should attempt to replace the tube using the obturator to keep the stoma open, or
insert a spare tube. Leaving the patient to call the provider or sealing the stoma can
lead to respiratory arrest.
9. A nurse is preparing to insert a nasogastric (NG) tube. How should the nurse
measure the correct insertion length?
A. From the tip of the nose to the umbilicus
B. From the mouth to the earlobe, then down to the xiphoid process
C. From the tip of the nose to the earlobe, then down to the xiphoid process
D. From the bridge of the nose to the sternal notch
Rationale: The correct anatomical measurement for an NG tube insertion length
stretches from the tip of the nose, to the earlobe, and straight down to the xiphoid
process of the sternum.
10. While assessing a patient's respiration, the nurse notes shallow breathing alternating
with periods of apnea. What is this breathing pattern called?
A. Kussmaul respirations
2|Page
, B. Cheyne-Stokes respirations
C. Bradypnea
D. Hyperventilation
Rationale: Cheyne-Stokes respirations feature cycles of deep breathing alternating
with shallow breathing, followed by periods of apnea. It is common in severe heart
failure or terminal clinical states. Kussmaul breathing is deep and rapid, typical of
diabetic ketoacidosis.
11. An RN is working with an Unlicensed Assistive Personnel (UAP). Which task must
be retained by the RN?
A. Measuring the output of a patient's Foley catheter bag
B. Feeding a stable patient who has mild left-sided weakness
C. Evaluating whether a patient's pain has decreased after medication
D. Assisting a patient to ambulate down the hallway with a walker
Rationale: Evaluation of medication effectiveness requires clinical judgment and
assessment skills, which cannot be delegated to an unlicensed worker. Measuring
outputs, routine feeding, and assisting with stable ambulation are appropriate tasks
for a UAP.
12. A nurse is preparing to change a patient's sterile wound dressing. Which action
ensures a sterile field is maintained?
A. Pouring sterile normal saline while holding the bottle label facing downward
B. Reaching across the sterile field to adjust a piece of gauze
C. Opening sterile supplies with the hands positioned over the field
D. Pouring sterile solution into a receptacle from 4 to 6 inches above the field
Rationale: Pouring fluids from a height of 4 to 6 inches prevents the unsterile bottle
from touching the sterile container. Reaching over a field or pouring with the label
down (causing drips to obscure the label) contaminates or risks contaminating the
field.
13. The nurse is caring for a patient with a suspected Clostridioides difficile (C. diff)
infection. Which infection control measure is mandatory?
A. Using an alcohol-based hand rub before leaving the room
B. Placing the patient in a negative-pressure airflow isolation room
C. Washing hands thoroughly with soap and water after patient care
D. Wearing an N95 respirator mask while inside the room
Rationale: C. diff spores are resistant to alcohol-based sanitizers. Physical friction
and rinsing with soap and water are mandatory to mechanically remove spores from
hands. Contact precautions require gowns and gloves, not negative pressure or N95
masks.
14. A nurse needs to administer an intramuscular (IM) injection to an infant. Which
muscle site is the safest choice?
A. Dorsogluteal muscle
B. Ventrogluteal muscle
C. Vastus lateralis muscle
D. Deltoid muscle
Rationale: The vastus lateralis (anterolateral thigh) is the most developed muscle in
infants and lacks major nerves or blood vessels, making it the safest site for an infant
IM injection. The dorsogluteal site is avoided due to sciatic nerve proximity.
15. What is the priority nursing action before administering any enteral feeding through a
nasogastric tube?
A. Warming the formula to body temperature in a microwave
B. Verifying correct placement of the tube according to hospital policy
3|Page
, C. Flushing the tube with 100 mL of sterile water
D. Placing the patient in a flat, supine position
Rationale: Verifying tube placement (via X-ray verification or checking gastric pH
contents) is vital to ensure the tube has not slipped into the lungs, which would
cause severe aspiration pneumonia. Feedings must always be given with the head
of the bed elevated at least 30 to 45 degrees.
16. A nurse notes that a patient has a blood pressure reading of 162/94 mmHg. How
should this be classified according to standard hypertension guidelines?
A. Elevated blood pressure
B. Stage 1 Hypertension
C. Stage 2 Hypertension
D. Hypertensive Crisis
Rationale: Stage 2 Hypertension is defined as a systolic pressure of 140 mmHg or
higher, or a diastolic pressure of 90 mmHg or higher. A reading of 162/94 mmHg
falls directly into this classification.
17. A patient with a Foley catheter requires a sterile urine sample for culture. How
should the nurse obtain this sample?
A. Disconnect the catheter from the tubing and drain it into a cup
B. Aspirate urine with a sterile syringe from the dedicated needleless sampling
port
C. Drain urine from the collection bag at the bottom of the bed
D. Swab the external surface of the collection bag and puncture it with a
needle
Rationale: Urine in the collection bag is stagnant and contaminated with bacteria
over time. A sterile sample must be aspirated directly from the needleless sampling
port after scrubbing it with an antiseptic wipe.
18. A nurse is assessing a patient with a dark skin tone for signs of cyanosis. Which
anatomical area provides the most accurate assessment?
A. The skin of the forearms and wrists
B. The conjunctivae, oral mucosa, and nail beds
C. The skin surrounding the ankles
D. The bridge of the nose and the cheeks
Rationale: In dark-skinned individuals, cyanosis and pallor are difficult to see in
general skin surfaces due to melanin pigmentation. Inspecting capillary-rich,
minimally pigmented sites like the oral mucosa, conjunctivae, and lips yields the
most accurate finding.
19. A nurse needs to assist a patient who is weak on their right side to transfer from the
bed to a chair. How should the nurse position the chair?
A. On the patient's weak (right) side at a 45-degree angle
B. On the patient's strong (left) side at a 45-degree angle
C. Directly facing the patient's knees at a 90-degree angle
D. Behind the patient's back on the bed wheels
Rationale: When transferring a patient with one-sided weakness, the chair should be
placed on their stronger side. This allows the patient to bear weight on the strong
limb and pivot safely into the chair.
20. What is the primary clinical purpose of performing a nursing assessment?
A. To establish a baseline database about the patient's health status and needs
B. To assign blame for errors that occurred during a prior shift
C. To prescribe medications that relieve acute patient symptoms
4|Page
Exam Questions And Well Graded Solutions
With Rationales Updated 2026-2027
Master your Chamberlain University NR224 Fundamentals Skills Exam with this comprehensive study
guide. Features highly detailed multiple-choice questions complete with underlined correct
answers and comprehensive, evidence-based rationales. Covers critical Week 3 and Week 5
milestones, including infection control, immobility complications, sterile catheter insertion,
oxygenation, and nursing delegation rules. Perfect for acing your lecture exams and clinical check-
off
1. A nurse is caring for an immobile patient. Which physiological change should the
nurse monitor for as a direct result of immobility?
A. Increased cardiac output
B. Decreased risk of urinary tract infections
C. Increased bone density
D. Calcium resorption from bones into the bloodstream
Rationale: Immobility leads to the breakdown of bone matrix, causing calcium to
leave the bones and enter the blood (resorption). This leads to osteoporosis and
hypercalcemia. Cardiac output actually decreases over time, urinary stasis increases
infection risks, and bone density decreases.
2. A patient is on prolonged bed rest. Which nursing intervention is most effective in
preventing deep vein thrombosis (DVT)?
A. Massaging the patient's calves daily
B. Applying sequential compression devices (SCDs) as ordered
C. Restricting fluid intake to 1 liter per day
D. Keeping the patient's knees flexed with a pillow
Rationale: Sequential compression devices (SCDs) promote venous return and
prevent venous stasis, which is the primary cause of DVT in immobile patients.
Massaging calves can dislodge an existing clot. Restricting fluids thickens blood, and
flexing knees restricts venous blood flow.
3. The nurse note a patient's surgical wound has a thick, yellow-green drainage. How
should the nurse document this finding?
A. Serous exudate
B. Sanguineous drainage
C. Purulent exudate
D. Serosanguineous drainage
Rationale: Purulent drainage is thick, malodorous, and varies in color (green, yellow,
or brown), indicating an active bacterial infection. Serous is clear/watery,
sanguineous is bright red blood, and serosanguineous is pink and watery.
4. A nurse is preparing to perform a sterile procedure. Which action breaks the
principles of surgical asepsis?
A. Keeping the sterile field above waist level
B. Turning the back toward the sterile field to grab a trash can
C. Opening the outermost flap of a sterile kit away from the body
D. Maintaining a 1-inch border around the edge as contaminated
Rationale: Turning your back on a sterile field breaks the principle of visual
monitoring; any field out of direct line of sight is considered contaminated. All other
options describe correct aseptic techniques.
1|Page
,5. A nurse prepares to administer a medication. The patient states, "This pill looks
different than the one I usually take at home." What is the nurse's priority action?
A. Reassure the patient that the hospital uses a different generic brand
B. Withhold the medication and re-verify the order in the electronic chart
C. Administer the medication and document the patient's concern
D. Ask the patient's family member to identify the pill
Rationale: Whenever a patient questions a medication, the nurse must halt
administration, re-verify the prescription, and check for pharmacy dispensing errors
to ensure patient safety. Never assume it is just a brand difference without checking.
6. A nurse is checking a patient's capillary refill time and notes it takes 4 seconds. How
should the nurse interpret this finding?
A. Normal peripheral tissue perfusion
B. Sluggish peripheral perfusion requiring further clinical evaluation
C. Adequate core body temperature
D. An expected physiological response to pain
Rationale: Normal capillary refill is less than 2 seconds. A refill time of 4 seconds
indicates delayed or sluggish peripheral perfusion, which may point to dehydration,
peripheral vascular disease, or low cardiac output.
7. A nurse is teaching a patient how to use an incentive spirometer. Which instruction is
correct?
A. Exhale forcefully and quickly into the mouthpiece
B. Inhale slowly and deeply through the mouthpiece to raise the indicator
C. Use the device once every shift while awake
D. Hold your breath for 30 seconds after inhaling
Rationale: An incentive spirometer requires slow, deep inhalations to maximize lung
expansion and prevent atelectasis. It should be used roughly 10 times every hour
while awake, holding the breath for 3 to 5 seconds at peak inhalation.
8. Which action should the nurse take first when a patient's tracheostomy tube
accidentally becomes dislodged?
A. Call the healthcare provider immediately from the nurses' station
B. Attempt to gently reinsert the tracheostomy tube using the obturator if
available
C. Cover the stoma completely with an occlusive dressing
D. Administer high-flow oxygen via a nasal cannula over the nose
Rationale: The immediate nursing priority is maintaining a patent airway. The nurse
should attempt to replace the tube using the obturator to keep the stoma open, or
insert a spare tube. Leaving the patient to call the provider or sealing the stoma can
lead to respiratory arrest.
9. A nurse is preparing to insert a nasogastric (NG) tube. How should the nurse
measure the correct insertion length?
A. From the tip of the nose to the umbilicus
B. From the mouth to the earlobe, then down to the xiphoid process
C. From the tip of the nose to the earlobe, then down to the xiphoid process
D. From the bridge of the nose to the sternal notch
Rationale: The correct anatomical measurement for an NG tube insertion length
stretches from the tip of the nose, to the earlobe, and straight down to the xiphoid
process of the sternum.
10. While assessing a patient's respiration, the nurse notes shallow breathing alternating
with periods of apnea. What is this breathing pattern called?
A. Kussmaul respirations
2|Page
, B. Cheyne-Stokes respirations
C. Bradypnea
D. Hyperventilation
Rationale: Cheyne-Stokes respirations feature cycles of deep breathing alternating
with shallow breathing, followed by periods of apnea. It is common in severe heart
failure or terminal clinical states. Kussmaul breathing is deep and rapid, typical of
diabetic ketoacidosis.
11. An RN is working with an Unlicensed Assistive Personnel (UAP). Which task must
be retained by the RN?
A. Measuring the output of a patient's Foley catheter bag
B. Feeding a stable patient who has mild left-sided weakness
C. Evaluating whether a patient's pain has decreased after medication
D. Assisting a patient to ambulate down the hallway with a walker
Rationale: Evaluation of medication effectiveness requires clinical judgment and
assessment skills, which cannot be delegated to an unlicensed worker. Measuring
outputs, routine feeding, and assisting with stable ambulation are appropriate tasks
for a UAP.
12. A nurse is preparing to change a patient's sterile wound dressing. Which action
ensures a sterile field is maintained?
A. Pouring sterile normal saline while holding the bottle label facing downward
B. Reaching across the sterile field to adjust a piece of gauze
C. Opening sterile supplies with the hands positioned over the field
D. Pouring sterile solution into a receptacle from 4 to 6 inches above the field
Rationale: Pouring fluids from a height of 4 to 6 inches prevents the unsterile bottle
from touching the sterile container. Reaching over a field or pouring with the label
down (causing drips to obscure the label) contaminates or risks contaminating the
field.
13. The nurse is caring for a patient with a suspected Clostridioides difficile (C. diff)
infection. Which infection control measure is mandatory?
A. Using an alcohol-based hand rub before leaving the room
B. Placing the patient in a negative-pressure airflow isolation room
C. Washing hands thoroughly with soap and water after patient care
D. Wearing an N95 respirator mask while inside the room
Rationale: C. diff spores are resistant to alcohol-based sanitizers. Physical friction
and rinsing with soap and water are mandatory to mechanically remove spores from
hands. Contact precautions require gowns and gloves, not negative pressure or N95
masks.
14. A nurse needs to administer an intramuscular (IM) injection to an infant. Which
muscle site is the safest choice?
A. Dorsogluteal muscle
B. Ventrogluteal muscle
C. Vastus lateralis muscle
D. Deltoid muscle
Rationale: The vastus lateralis (anterolateral thigh) is the most developed muscle in
infants and lacks major nerves or blood vessels, making it the safest site for an infant
IM injection. The dorsogluteal site is avoided due to sciatic nerve proximity.
15. What is the priority nursing action before administering any enteral feeding through a
nasogastric tube?
A. Warming the formula to body temperature in a microwave
B. Verifying correct placement of the tube according to hospital policy
3|Page
, C. Flushing the tube with 100 mL of sterile water
D. Placing the patient in a flat, supine position
Rationale: Verifying tube placement (via X-ray verification or checking gastric pH
contents) is vital to ensure the tube has not slipped into the lungs, which would
cause severe aspiration pneumonia. Feedings must always be given with the head
of the bed elevated at least 30 to 45 degrees.
16. A nurse notes that a patient has a blood pressure reading of 162/94 mmHg. How
should this be classified according to standard hypertension guidelines?
A. Elevated blood pressure
B. Stage 1 Hypertension
C. Stage 2 Hypertension
D. Hypertensive Crisis
Rationale: Stage 2 Hypertension is defined as a systolic pressure of 140 mmHg or
higher, or a diastolic pressure of 90 mmHg or higher. A reading of 162/94 mmHg
falls directly into this classification.
17. A patient with a Foley catheter requires a sterile urine sample for culture. How
should the nurse obtain this sample?
A. Disconnect the catheter from the tubing and drain it into a cup
B. Aspirate urine with a sterile syringe from the dedicated needleless sampling
port
C. Drain urine from the collection bag at the bottom of the bed
D. Swab the external surface of the collection bag and puncture it with a
needle
Rationale: Urine in the collection bag is stagnant and contaminated with bacteria
over time. A sterile sample must be aspirated directly from the needleless sampling
port after scrubbing it with an antiseptic wipe.
18. A nurse is assessing a patient with a dark skin tone for signs of cyanosis. Which
anatomical area provides the most accurate assessment?
A. The skin of the forearms and wrists
B. The conjunctivae, oral mucosa, and nail beds
C. The skin surrounding the ankles
D. The bridge of the nose and the cheeks
Rationale: In dark-skinned individuals, cyanosis and pallor are difficult to see in
general skin surfaces due to melanin pigmentation. Inspecting capillary-rich,
minimally pigmented sites like the oral mucosa, conjunctivae, and lips yields the
most accurate finding.
19. A nurse needs to assist a patient who is weak on their right side to transfer from the
bed to a chair. How should the nurse position the chair?
A. On the patient's weak (right) side at a 45-degree angle
B. On the patient's strong (left) side at a 45-degree angle
C. Directly facing the patient's knees at a 90-degree angle
D. Behind the patient's back on the bed wheels
Rationale: When transferring a patient with one-sided weakness, the chair should be
placed on their stronger side. This allows the patient to bear weight on the strong
limb and pivot safely into the chair.
20. What is the primary clinical purpose of performing a nursing assessment?
A. To establish a baseline database about the patient's health status and needs
B. To assign blame for errors that occurred during a prior shift
C. To prescribe medications that relieve acute patient symptoms
4|Page
