Fundamentals of Nursing:
Comprehensive Exam Review
55 Evidence-Based Practice Questions with Correct Answers and Rationales | 2026/2027
Aligned with NCSBN NCLEX-RN Safe and Effective Care Environment & Health Promotion Domains, ANA Scope &
Standards, CDC Infection Control Guidelines, and The Joint Commission National Patient Safety Goals
, Abstract
This Comprehensive Exam Review provides 55 evidence-based practice questions designed for pre-
licensure Bachelor of Science in Nursing (BSN) and Associate Degree in Nursing (ADN) students
preparing for the NCLEX-RN examination. The questions are organized across six foundational domains
aligned with the NCSBN NCLEX-RN Test Plan: Nursing Process and Critical Thinking, Therapeutic
Communication and Documentation, Safety and Infection Control, Legal and Ethical Foundations, Vital
Signs and Patient Education, and Prioritization and Delegation. Each question emphasizes the ADPIE
(Assessment, Diagnosis, Planning, Implementation, Evaluation) framework as the cornerstone of clinical
reasoning. Correct answers are accompanied by rationales referencing NCSBN, ANA, CDC, and Joint
Commission standards to reinforce evidence-based practice. This resource supports students in developing
clinical judgment competencies and bridging didactic learning with safe, effective patient care.
Keywords: fundamentals of nursing, ADPIE, therapeutic communication, infection control, patient safety,
delegation, vital signs, clinical judgment
Domain Distribution
Domain Focus Area Questions Approx. Weight
1: Nursing Process & Critical ADPIE, NANDA-I, SMART goals, Q1–Q15 27%
Thinking Foundations critical thinking attributes
2: Therapeutic Communication & Active listening, non-therapeutic Q16–Q25 18%
Documentation responses, SBAR, documentation
standards
3: Safety, Infection Control & Standard/transmission-based Q26–Q35 18%
Basic Care precautions, falls, restraints, ADLs
4: Legal/Ethical Foundations & NPA, scope, informed consent, HIPAA, Q36–Q42 13%
Professionalism mandatory reporting, ANA Code
5: Vital Signs, Basic Assessment Vital sign norms/techniques, basic Q43–Q49 13%
& Patient Education assessment, teach-back, health literacy
6: Prioritization, Delegation & ABCs/Maslow, Five Rights of Q50–Q55 11%
NGN Integration Delegation, CJMM, NGN items
Domain 1: Nursing Process & Critical Thinking Foundations (Q1–Q15)
1. A nurse is performing an initial assessment on a newly admitted patient. Which of the following is an example
of subjective data?
A. Blood pressure 148/92 mmHg
B. Respiratory rate 22 breaths/min
C. The patient states, 'I feel a sharp pain in my chest when I take a deep breath'
D. Skin is warm and diaphoretic to palpation
Correct Answer: C. The patient states, 'I feel a sharp pain in my chest when I take a deep breath'
Rationale: Subjective data is information perceived, felt, or reported by the patient and cannot be measured directly
by the nurse (NCSBN NCLEX-RN Test Plan, Safe and Effective Care Environment). Objective data such as vital signs
and physical findings are measurable and observable through assessment techniques.
2
, 2. Which statement correctly differentiates a nursing diagnosis from a medical diagnosis?
A. A nursing diagnosis focuses on the disease process affecting a body system.
B. A nursing diagnosis identifies human responses to health conditions and life processes.
C. A medical diagnosis is formulated using the NANDA-I taxonomy.
D. A nursing diagnosis requires a physician's order before implementation.
Correct Answer: B. A nursing diagnosis identifies human responses to health conditions and life
processes.
Rationale: NANDA-I defines a nursing diagnosis as a clinical judgment about human responses to health conditions
or life processes that the nurse is licensed to treat (ANA Scope & Standards of Practice, 2021). Medical diagnoses
identify pathology and are within the physician scope; nursing diagnoses guide independent nursing interventions.
3. A nurse writes the following diagnosis: 'Impaired Gas Exchange related to alveolar-capillary membrane
changes as evidenced by SpO2 of 88% and dyspnea on exertion.' Which component represents the etiology?
A. Impaired Gas Exchange
B. alveolar-capillary membrane changes
C. SpO2 of 88% and dyspnea on exertion
D. Impaired Gas Exchange related to alveolar-capillary membrane changes
Correct Answer: B. alveolar-capillary membrane changes
Rationale: The NANDA-I PES (Problem-Etiology-Symptoms) format structures nursing diagnoses into three parts:
the problem (diagnostic label), the etiology (related factor), and the defining characteristics or signs/symptoms
(NCSBN Clinical Judgment Measurement Model). The etiology directs nursing interventions and must be modifiable
through nursing actions.
4. A nurse is developing a care plan for a patient recovering from a stroke. Which goal statement best
demonstrates the SMART criteria?
A. The patient will improve mobility within a few weeks.
B. The patient will walk 50 feet with a cane independently by discharge on day 7.
C. The patient will understand the importance of physical therapy.
D. The patient will feel better about their condition soon.
Correct Answer: B. The patient will walk 50 feet with a cane independently by discharge on day 7.
Rationale: SMART goals are Specific, Measurable, Achievable, Relevant, and Time-bound (ANA Standards of
Practice). This goal specifies a measurable distance (50 feet), an assistive device (cane), independence level, and a
concrete deadline (day 7), allowing objective evaluation of outcomes.
5. During the evaluation phase of the nursing process, a nurse finds that a patient's pain has not decreased below
4/10 despite administered interventions. What is the nurse's most appropriate next action?
A. Discontinue the current plan of care as ineffective.
B. Document the findings and reassess during the next scheduled shift.
C. Revise the care plan by modifying interventions or setting new goals.
D. Notify the physician that the patient is noncompliant with treatment.
Correct Answer: C. Revise the care plan by modifying interventions or setting new goals.
3
Comprehensive Exam Review
55 Evidence-Based Practice Questions with Correct Answers and Rationales | 2026/2027
Aligned with NCSBN NCLEX-RN Safe and Effective Care Environment & Health Promotion Domains, ANA Scope &
Standards, CDC Infection Control Guidelines, and The Joint Commission National Patient Safety Goals
, Abstract
This Comprehensive Exam Review provides 55 evidence-based practice questions designed for pre-
licensure Bachelor of Science in Nursing (BSN) and Associate Degree in Nursing (ADN) students
preparing for the NCLEX-RN examination. The questions are organized across six foundational domains
aligned with the NCSBN NCLEX-RN Test Plan: Nursing Process and Critical Thinking, Therapeutic
Communication and Documentation, Safety and Infection Control, Legal and Ethical Foundations, Vital
Signs and Patient Education, and Prioritization and Delegation. Each question emphasizes the ADPIE
(Assessment, Diagnosis, Planning, Implementation, Evaluation) framework as the cornerstone of clinical
reasoning. Correct answers are accompanied by rationales referencing NCSBN, ANA, CDC, and Joint
Commission standards to reinforce evidence-based practice. This resource supports students in developing
clinical judgment competencies and bridging didactic learning with safe, effective patient care.
Keywords: fundamentals of nursing, ADPIE, therapeutic communication, infection control, patient safety,
delegation, vital signs, clinical judgment
Domain Distribution
Domain Focus Area Questions Approx. Weight
1: Nursing Process & Critical ADPIE, NANDA-I, SMART goals, Q1–Q15 27%
Thinking Foundations critical thinking attributes
2: Therapeutic Communication & Active listening, non-therapeutic Q16–Q25 18%
Documentation responses, SBAR, documentation
standards
3: Safety, Infection Control & Standard/transmission-based Q26–Q35 18%
Basic Care precautions, falls, restraints, ADLs
4: Legal/Ethical Foundations & NPA, scope, informed consent, HIPAA, Q36–Q42 13%
Professionalism mandatory reporting, ANA Code
5: Vital Signs, Basic Assessment Vital sign norms/techniques, basic Q43–Q49 13%
& Patient Education assessment, teach-back, health literacy
6: Prioritization, Delegation & ABCs/Maslow, Five Rights of Q50–Q55 11%
NGN Integration Delegation, CJMM, NGN items
Domain 1: Nursing Process & Critical Thinking Foundations (Q1–Q15)
1. A nurse is performing an initial assessment on a newly admitted patient. Which of the following is an example
of subjective data?
A. Blood pressure 148/92 mmHg
B. Respiratory rate 22 breaths/min
C. The patient states, 'I feel a sharp pain in my chest when I take a deep breath'
D. Skin is warm and diaphoretic to palpation
Correct Answer: C. The patient states, 'I feel a sharp pain in my chest when I take a deep breath'
Rationale: Subjective data is information perceived, felt, or reported by the patient and cannot be measured directly
by the nurse (NCSBN NCLEX-RN Test Plan, Safe and Effective Care Environment). Objective data such as vital signs
and physical findings are measurable and observable through assessment techniques.
2
, 2. Which statement correctly differentiates a nursing diagnosis from a medical diagnosis?
A. A nursing diagnosis focuses on the disease process affecting a body system.
B. A nursing diagnosis identifies human responses to health conditions and life processes.
C. A medical diagnosis is formulated using the NANDA-I taxonomy.
D. A nursing diagnosis requires a physician's order before implementation.
Correct Answer: B. A nursing diagnosis identifies human responses to health conditions and life
processes.
Rationale: NANDA-I defines a nursing diagnosis as a clinical judgment about human responses to health conditions
or life processes that the nurse is licensed to treat (ANA Scope & Standards of Practice, 2021). Medical diagnoses
identify pathology and are within the physician scope; nursing diagnoses guide independent nursing interventions.
3. A nurse writes the following diagnosis: 'Impaired Gas Exchange related to alveolar-capillary membrane
changes as evidenced by SpO2 of 88% and dyspnea on exertion.' Which component represents the etiology?
A. Impaired Gas Exchange
B. alveolar-capillary membrane changes
C. SpO2 of 88% and dyspnea on exertion
D. Impaired Gas Exchange related to alveolar-capillary membrane changes
Correct Answer: B. alveolar-capillary membrane changes
Rationale: The NANDA-I PES (Problem-Etiology-Symptoms) format structures nursing diagnoses into three parts:
the problem (diagnostic label), the etiology (related factor), and the defining characteristics or signs/symptoms
(NCSBN Clinical Judgment Measurement Model). The etiology directs nursing interventions and must be modifiable
through nursing actions.
4. A nurse is developing a care plan for a patient recovering from a stroke. Which goal statement best
demonstrates the SMART criteria?
A. The patient will improve mobility within a few weeks.
B. The patient will walk 50 feet with a cane independently by discharge on day 7.
C. The patient will understand the importance of physical therapy.
D. The patient will feel better about their condition soon.
Correct Answer: B. The patient will walk 50 feet with a cane independently by discharge on day 7.
Rationale: SMART goals are Specific, Measurable, Achievable, Relevant, and Time-bound (ANA Standards of
Practice). This goal specifies a measurable distance (50 feet), an assistive device (cane), independence level, and a
concrete deadline (day 7), allowing objective evaluation of outcomes.
5. During the evaluation phase of the nursing process, a nurse finds that a patient's pain has not decreased below
4/10 despite administered interventions. What is the nurse's most appropriate next action?
A. Discontinue the current plan of care as ineffective.
B. Document the findings and reassess during the next scheduled shift.
C. Revise the care plan by modifying interventions or setting new goals.
D. Notify the physician that the patient is noncompliant with treatment.
Correct Answer: C. Revise the care plan by modifying interventions or setting new goals.
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