FITZ Exit Exam ACTUAL EXAM 2026/2027 |
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Section 1: Medical-Surgical Nursing (Questions 1–25)
Q1: A 68-year-old male with a history of heart failure presents with jugular vein distension, 3+ pitting
edema in bilateral lower extremities, and crackles halfway up both lung fields. Vital signs: BP 158/92, HR
110, RR 28, O2 saturation 89% on room air. Which intervention should the nurse implement first?
A. Place the patient in high Fowler's position. [CORRECT]
B. Administer furosemide 40 mg IV push.
C. Apply a non-rebreather mask at 15 L/min.
D. Restrict oral fluids to 1500 mL per day.
Correct Answer: A
Rationale: High Fowler's position reduces venous return (preload) and improves breathing mechanics
immediately for pulmonary edema. Distractor B (furosemide) is correct but not first—positioning is
instantaneous and non-invasive. Distractor C (oxygen) is appropriate but positioning optimizes
oxygenation before applying the device. Distractor D (fluid restriction) is chronic management, not an
emergency intervention. Test-taking strategy: For acute respiratory distress, always prioritize positioning
and airway before medications.
Q2: A patient is admitted with syndrome of inappropriate antidiuretic hormone (SIADH). Which
assessment finding requires immediate intervention?
A. Urine specific gravity of 1.030.
B. Serum sodium level of 110 mEq/L. [CORRECT]
C. Weight gain of 2 lbs in 24 hours.
D. Urine osmolality of 400 mOsm/kg.
,Correct Answer: B
Rationale: A serum sodium of 110 mEq/L indicates severe hyponatremia, which poses an immediate risk
for cerebral edema, seizures, and coma. Distractor A (high specific gravity) and D (high osmolality) are
expected in SIADH but less critical than the sodium level. Distractor C (weight gain) is a symptom of the
fluid retention but not the immediate life threat. Test-taking strategy: In electrolyte imbalances, identify
the value that poses an immediate threat to life (seizures/respiratory arrest).
Q3: A nurse is caring for a patient with a chest tube connected to a water-seal drainage system. Which
finding indicates the lung has re-expanded?
A. Continuous bubbling in the water-seal chamber.
B. Gentle tidaling in the water-seal chamber.
C. Absence of tidaling in the water-seal chamber. [CORRECT]
D. Drainage of 100 mL/hr of serosanguineous fluid.
Correct Answer: C
Rationale: When the lung re-expands, the pleural space is obliterated, and negative pressure is restored;
thus, tidaling stops. Distractor A indicates an air leak. Distractor B indicates the lung is still
expanding/contracting (normal functioning chest tube). Distractor D indicates active drainage, not
necessarily re-expansion. Test-taking strategy: Know the difference between functioning chest tubes
(tidaling) and resolved pneumothorax (no tidaling).
Q4: A patient with chronic kidney disease (CKD) is receiving hemodialysis. Which dietary instruction is
essential for the nurse to include?
A. Increase potassium intake to prevent hypokalemia.
B. Limit protein intake to 0.6 g/kg/day.
C. Restrict fluid intake to 1-2 L/day depending on urine output. [CORRECT]
D. Consume a high-phosphorus diet to maintain bone density.
,Correct Answer: C
Rationale: Fluid restriction prevents fluid overload and heart failure between dialysis sessions. Distractor
A is incorrect as CKD patients are hyperkalemic. Distractor B is outdated; patients on dialysis often need
increased protein due to amino acid loss. Distractor D is incorrect; phosphorus is restricted. Test-taking
strategy: Remember "PUF" – Potassium, Urea/Protein, Fluid/Phosphorus restrictions apply to CKD.
Q5: NGN Bow-Tie Question A 55-year-old male with cirrhosis presents with confusion and asterixis.
Condition: The patient is at risk for Hepatic Encephalopathy.
Action: The nurse should administer Lactulose.
Outcome: The intended outcome is Reduction of serum ammonia levels.
Which option correctly completes the bow-tie?
A. Condition: Hepatorenal Syndrome; Action: Spironolactone; Outcome: Increased urine output.
B. Condition: Hepatic Encephalopathy; Action: Lactulose; Outcome: Reduction of serum ammonia levels.
[CORRECT]
C. Condition: Esophageal Varices; Action: Octreotide; Outcome: Vasoconstriction.
D. Condition: Ascites; Action: Paracentesis; Outcome: Immediate diuresis.
Correct Answer: B
Rationale: Hepatic encephalopathy is caused by ammonia accumulation. Lactulose traps ammonia in the
gut to be excreted. Distractor A relates to kidney failure. Distractor C relates to bleeding. Distractor D
relates to fluid accumulation. Test-taking strategy: Link the pathophysiology (ammonia) to the specific
treatment (lactulose).
Q6: A patient is admitted with a diagnosis of Addison’s disease. Which assessment finding does the
nurse expect?
A. Hypertension and hypokalemia.
B. Moon face and buffalo hump.
C. Hypotension and hyperkalemia. [CORRECT]
D. Tachycardia and exophthalmos.
, Correct Answer: C
Rationale: Addison’s disease involves adrenal insufficiency, leading to a lack of aldosterone (causing
sodium loss/hypotension) and lack of cortisol. Hyperkalemia occurs due to lack of aldosterone.
Distractor A and B are signs of Cushing's syndrome (excess cortisol). Distractor D is Graves' disease. Test-
taking strategy: Addison’s = Addisonian Crisis = Low BP, Low Sodium, High Potassium. Cushing's =
Opposite.
Q7: The nurse is caring for a patient with a tracheostomy. Which intervention is most effective in
preventing tracheostomy tube displacement?
A. Keeping the patient in supine position.
B. Using a twill tie or Velcro holder secured tightly. [CORRECT]
C. Suctioning the airway every 2 hours.
D. Humidifying the inspired air.
Correct Answer: B
Rationale: Securing the tube properly prevents displacement. Distractor A increases the risk of
aspiration and does not secure the tube. Distractor C clears secretions but does not physically hold the
tube. Distractor D prevents mucus plugs but does not secure the tube. Test-taking strategy: Differentiate
between "preventing displacement" (security) and "preventing occlusion" (suction/humidity).
Q8: A patient receiving a blood transfusion develops lower back pain, chills, and dark urine. What is the
nurse's priority action?
A. Slow the transfusion rate and notify the provider.
B. Stop the transfusion immediately and maintain IV access with normal saline. [CORRECT]
C. Administer diphenhydramine and acetaminophen.
D. Collect a urine sample and send to the lab.
Correct Answer: B
Fitz Exit Comprehensive Review | Verified Q&A |
Pass Guaranteed - A+ Graded
Section 1: Medical-Surgical Nursing (Questions 1–25)
Q1: A 68-year-old male with a history of heart failure presents with jugular vein distension, 3+ pitting
edema in bilateral lower extremities, and crackles halfway up both lung fields. Vital signs: BP 158/92, HR
110, RR 28, O2 saturation 89% on room air. Which intervention should the nurse implement first?
A. Place the patient in high Fowler's position. [CORRECT]
B. Administer furosemide 40 mg IV push.
C. Apply a non-rebreather mask at 15 L/min.
D. Restrict oral fluids to 1500 mL per day.
Correct Answer: A
Rationale: High Fowler's position reduces venous return (preload) and improves breathing mechanics
immediately for pulmonary edema. Distractor B (furosemide) is correct but not first—positioning is
instantaneous and non-invasive. Distractor C (oxygen) is appropriate but positioning optimizes
oxygenation before applying the device. Distractor D (fluid restriction) is chronic management, not an
emergency intervention. Test-taking strategy: For acute respiratory distress, always prioritize positioning
and airway before medications.
Q2: A patient is admitted with syndrome of inappropriate antidiuretic hormone (SIADH). Which
assessment finding requires immediate intervention?
A. Urine specific gravity of 1.030.
B. Serum sodium level of 110 mEq/L. [CORRECT]
C. Weight gain of 2 lbs in 24 hours.
D. Urine osmolality of 400 mOsm/kg.
,Correct Answer: B
Rationale: A serum sodium of 110 mEq/L indicates severe hyponatremia, which poses an immediate risk
for cerebral edema, seizures, and coma. Distractor A (high specific gravity) and D (high osmolality) are
expected in SIADH but less critical than the sodium level. Distractor C (weight gain) is a symptom of the
fluid retention but not the immediate life threat. Test-taking strategy: In electrolyte imbalances, identify
the value that poses an immediate threat to life (seizures/respiratory arrest).
Q3: A nurse is caring for a patient with a chest tube connected to a water-seal drainage system. Which
finding indicates the lung has re-expanded?
A. Continuous bubbling in the water-seal chamber.
B. Gentle tidaling in the water-seal chamber.
C. Absence of tidaling in the water-seal chamber. [CORRECT]
D. Drainage of 100 mL/hr of serosanguineous fluid.
Correct Answer: C
Rationale: When the lung re-expands, the pleural space is obliterated, and negative pressure is restored;
thus, tidaling stops. Distractor A indicates an air leak. Distractor B indicates the lung is still
expanding/contracting (normal functioning chest tube). Distractor D indicates active drainage, not
necessarily re-expansion. Test-taking strategy: Know the difference between functioning chest tubes
(tidaling) and resolved pneumothorax (no tidaling).
Q4: A patient with chronic kidney disease (CKD) is receiving hemodialysis. Which dietary instruction is
essential for the nurse to include?
A. Increase potassium intake to prevent hypokalemia.
B. Limit protein intake to 0.6 g/kg/day.
C. Restrict fluid intake to 1-2 L/day depending on urine output. [CORRECT]
D. Consume a high-phosphorus diet to maintain bone density.
,Correct Answer: C
Rationale: Fluid restriction prevents fluid overload and heart failure between dialysis sessions. Distractor
A is incorrect as CKD patients are hyperkalemic. Distractor B is outdated; patients on dialysis often need
increased protein due to amino acid loss. Distractor D is incorrect; phosphorus is restricted. Test-taking
strategy: Remember "PUF" – Potassium, Urea/Protein, Fluid/Phosphorus restrictions apply to CKD.
Q5: NGN Bow-Tie Question A 55-year-old male with cirrhosis presents with confusion and asterixis.
Condition: The patient is at risk for Hepatic Encephalopathy.
Action: The nurse should administer Lactulose.
Outcome: The intended outcome is Reduction of serum ammonia levels.
Which option correctly completes the bow-tie?
A. Condition: Hepatorenal Syndrome; Action: Spironolactone; Outcome: Increased urine output.
B. Condition: Hepatic Encephalopathy; Action: Lactulose; Outcome: Reduction of serum ammonia levels.
[CORRECT]
C. Condition: Esophageal Varices; Action: Octreotide; Outcome: Vasoconstriction.
D. Condition: Ascites; Action: Paracentesis; Outcome: Immediate diuresis.
Correct Answer: B
Rationale: Hepatic encephalopathy is caused by ammonia accumulation. Lactulose traps ammonia in the
gut to be excreted. Distractor A relates to kidney failure. Distractor C relates to bleeding. Distractor D
relates to fluid accumulation. Test-taking strategy: Link the pathophysiology (ammonia) to the specific
treatment (lactulose).
Q6: A patient is admitted with a diagnosis of Addison’s disease. Which assessment finding does the
nurse expect?
A. Hypertension and hypokalemia.
B. Moon face and buffalo hump.
C. Hypotension and hyperkalemia. [CORRECT]
D. Tachycardia and exophthalmos.
, Correct Answer: C
Rationale: Addison’s disease involves adrenal insufficiency, leading to a lack of aldosterone (causing
sodium loss/hypotension) and lack of cortisol. Hyperkalemia occurs due to lack of aldosterone.
Distractor A and B are signs of Cushing's syndrome (excess cortisol). Distractor D is Graves' disease. Test-
taking strategy: Addison’s = Addisonian Crisis = Low BP, Low Sodium, High Potassium. Cushing's =
Opposite.
Q7: The nurse is caring for a patient with a tracheostomy. Which intervention is most effective in
preventing tracheostomy tube displacement?
A. Keeping the patient in supine position.
B. Using a twill tie or Velcro holder secured tightly. [CORRECT]
C. Suctioning the airway every 2 hours.
D. Humidifying the inspired air.
Correct Answer: B
Rationale: Securing the tube properly prevents displacement. Distractor A increases the risk of
aspiration and does not secure the tube. Distractor C clears secretions but does not physically hold the
tube. Distractor D prevents mucus plugs but does not secure the tube. Test-taking strategy: Differentiate
between "preventing displacement" (security) and "preventing occlusion" (suction/humidity).
Q8: A patient receiving a blood transfusion develops lower back pain, chills, and dark urine. What is the
nurse's priority action?
A. Slow the transfusion rate and notify the provider.
B. Stop the transfusion immediately and maintain IV access with normal saline. [CORRECT]
C. Administer diphenhydramine and acetaminophen.
D. Collect a urine sample and send to the lab.
Correct Answer: B
