Fundamentals of Nursing Final Exam
ACTUAL EXAM 2026/2027 | Nursing
Fundamentals Final | Verified Q&A |
Pass Guaranteed - A+ Graded
Total Questions: 100 | Time Suggested: 2 hours (120 minutes)
SECTION 1: SAFETY & INFECTION CONTROL (Questions 1–15)
Q1. A nurse is caring for a client on contact precautions for Clostridioides difficile (C. diff). Which action
by the nurse demonstrates correct infection control practice?
A. Removing gloves and washing hands with alcohol-based hand rub before leaving the room
B. Using a dedicated stethoscope that remains in the client's room
C. Wearing a surgical mask when entering the room
D. Placing the client in a negative pressure room
Correct Answer: B
Rationale: For contact precautions, equipment used for the client (stethoscope, blood pressure cuff)
should be dedicated to that client and remain in the room to prevent transmission to other patients.
Alcohol-based hand rub is ineffective against C. diff spores—soap and water must be used. Masks are
not required for contact precautions alone. Negative pressure is for airborne precautions (TB, measles,
chickenpox).
Q2. A nurse is preparing to administer medications to four clients. Which client should the nurse see
first?
A. A client requesting pain medication 30 minutes early
B. A client with a new order for IV antibiotics due in 1 hour
C. A client with a blood pressure of 88/52 mm Hg and heart rate of 118 bpm
D. A client ready for discharge teaching
,Correct Answer: C
Rationale: This client is hemodynamically unstable with hypotension and tachycardia, indicating possible
shock, bleeding, or severe dehydration. The nurse must assess this client first using the ABC priority
framework. The airway is not compromised, but breathing and circulation are threatened by low BP and
high HR. This is a priority over scheduled medications, pain management (non-urgent unless severe),
and discharge teaching.
Q3. [SELECT ALL THAT APPLY] A nurse is implementing standard precautions. Which actions are
required? (Select all that apply.)
A. Wearing gloves when touching blood, body fluids, or contaminated surfaces
B. Wearing a gown when there is risk of splashing blood or body fluids
C. Wearing a mask and eye protection during suctioning or procedures that generate splashes
D. Washing hands with soap and water after removing gloves
E. Placing all clients in private rooms
F. Using dedicated equipment for each client
Correct Answers: A, B, C, D
Rationale: Standard precautions apply to all clients regardless of diagnosis. Gloves (A), gowns (B), and
mask/eye protection (C) are used based on anticipated exposure to blood or body fluids. Hand hygiene
after glove removal (D) is essential because gloves have microtears. Private rooms (E) are transmission-
based precautions, not standard precautions. Dedicated equipment (F) is for contact precautions, not
standard precautions.
Q4. A nurse witnesses a client fall in the bathroom. After ensuring the client is safe, which action should
the nurse take next?
A. Complete the incident report before the end of the shift
B. Document the fall in the client's medical record
C. Notify the provider and family immediately
D. Reassess the client for injuries and vital signs
Correct Answer: D
Rationale: After ensuring immediate safety, the nurse must reassess the client for injuries (head trauma,
fractures, lacerations) and obtain vital signs to detect internal bleeding or shock. This follows the nursing
process: assessment comes before documentation, reporting, or notification. While incident reports (A)
and provider notification (C) are important, they follow the assessment that determines the urgency and
nature of injuries. Documentation (B) should be objective and factual, completed after assessment and
interventions.
,Q5. [ORDERED RESPONSE – PRIORITY] A fire breaks out in a client's room. Place the nurse's actions in
the correct order using the RACE protocol.
1. Activate the fire alarm and call the hospital operator
2. Confine the fire by closing doors and windows
3. Evacuate clients from the immediate area
4. Extinguish the fire if small and contained, using PASS technique
Correct Answer: 1, 3, 2, 4
Rationale: RACE stands for Rescue, Alarm, Confine, Extinguish. First, rescue (evacuate) clients from
immediate danger (3). Then activate the alarm (1) to alert others and summon help. Confine the fire (2)
by closing doors and windows to limit oxygen and slow spread. Extinguish (4) only if the fire is small,
contained, and the nurse has a clear exit—never risk becoming trapped. This sequence prioritizes life
safety over property, following fire safety protocols for healthcare facilities.
Q6. A nurse is caring for a client who requires wrist restraints to prevent removal of a nasogastric tube.
Which nursing action is required by The Joint Commission?
A. Remove the restraints every 4 hours for range-of-motion exercises
B. Obtain a provider's order for restraints within 1 hour of application
C. Document the client's behavior every 15 minutes while in restraints
D. Release the restraints every 2 hours for toileting and meals
Correct Answer: B
Rationale: The Joint Commission requires a provider's order for restraints within 1 hour of application
for non-violent behavior (such as medical device removal). The order must specify the type of restraint,
reason, and duration. While ROM exercises (A), frequent documentation (C), and release for care (D) are
good practices, the 1-hour provider order is the specific regulatory requirement. Restraints are a last
resort after less restrictive alternatives have been attempted, and the nurse must reassess the need for
continued restraints regularly.
Q7. [DELEGATION TO UAP/LPN] A nurse is caring for a client who is on fall precautions. Which task is
appropriate to delegate to the UAP?
A. Assessing the client's risk for falls using the Morse Fall Scale
B. Keeping the call light within reach and ensuring the bed is in the lowest position
C. Teaching the client and family about fall prevention strategies
D. Evaluating the effectiveness of fall precaution interventions
, Correct Answer: B
Rationale: Keeping the call light within reach and the bed in the lowest position are task-oriented
interventions within UAP scope—environmental safety measures that prevent falls. Assessing fall risk (A)
requires nursing judgment and use of validated tools. Teaching (C) requires education skills and
knowledge of fall prevention principles. Evaluating effectiveness (D) is nursing assessment. The UAP
implements the environmental components of the fall prevention plan while the nurse manages
assessment, education, and evaluation.
Q8. A nurse sustains a needlestick injury while drawing blood from a client with unknown HIV status.
Which action should the nurse take first?
A. Complete the incident report and notify employee health
B. Wash the puncture site with soap and water
C. Squeeze the wound to express blood
D. Apply pressure and a bandage to the wound
Correct Answer: B
Rationale: Immediate washing with soap and water is the first and most important step after a
needlestick. This mechanical action removes contaminated blood and reduces viral load exposure.
Squeezing the wound (C) is no longer recommended as it may increase tissue damage and viral entry.
Pressure and bandage (D) follow washing. Incident reporting (A) is essential but does not take
precedence over immediate first aid. The nurse should then report to employee health for risk
assessment, baseline testing, and potential post-exposure prophylaxis within 2 hours.
Q9. [SELECT ALL THAT APPLY] A nurse is preparing to enter the room of a client with airborne
precautions for tuberculosis. Which PPE is required? (Select all that apply.)
A. N95 respirator or powered air-purifying respirator (PAPR)
B. Gloves
C. Gown
D. Face shield
E. Surgical mask
F. Shoe covers
Correct Answers: A, B
Rationale: Airborne precautions require an N95 respirator (A) because tuberculosis bacilli are
transmitted via droplet nuclei (<5 microns) that remain suspended in air. Gloves (B) are part of standard
precautions and should be worn when touching the client or environment. Gowns (C) are for contact
precautions or when there is risk of soiling. Face shields (D) protect against splashes. Surgical masks (E)
do not filter airborne particles and are not sufficient for TB. Shoe covers (F) are not part of standard
ACTUAL EXAM 2026/2027 | Nursing
Fundamentals Final | Verified Q&A |
Pass Guaranteed - A+ Graded
Total Questions: 100 | Time Suggested: 2 hours (120 minutes)
SECTION 1: SAFETY & INFECTION CONTROL (Questions 1–15)
Q1. A nurse is caring for a client on contact precautions for Clostridioides difficile (C. diff). Which action
by the nurse demonstrates correct infection control practice?
A. Removing gloves and washing hands with alcohol-based hand rub before leaving the room
B. Using a dedicated stethoscope that remains in the client's room
C. Wearing a surgical mask when entering the room
D. Placing the client in a negative pressure room
Correct Answer: B
Rationale: For contact precautions, equipment used for the client (stethoscope, blood pressure cuff)
should be dedicated to that client and remain in the room to prevent transmission to other patients.
Alcohol-based hand rub is ineffective against C. diff spores—soap and water must be used. Masks are
not required for contact precautions alone. Negative pressure is for airborne precautions (TB, measles,
chickenpox).
Q2. A nurse is preparing to administer medications to four clients. Which client should the nurse see
first?
A. A client requesting pain medication 30 minutes early
B. A client with a new order for IV antibiotics due in 1 hour
C. A client with a blood pressure of 88/52 mm Hg and heart rate of 118 bpm
D. A client ready for discharge teaching
,Correct Answer: C
Rationale: This client is hemodynamically unstable with hypotension and tachycardia, indicating possible
shock, bleeding, or severe dehydration. The nurse must assess this client first using the ABC priority
framework. The airway is not compromised, but breathing and circulation are threatened by low BP and
high HR. This is a priority over scheduled medications, pain management (non-urgent unless severe),
and discharge teaching.
Q3. [SELECT ALL THAT APPLY] A nurse is implementing standard precautions. Which actions are
required? (Select all that apply.)
A. Wearing gloves when touching blood, body fluids, or contaminated surfaces
B. Wearing a gown when there is risk of splashing blood or body fluids
C. Wearing a mask and eye protection during suctioning or procedures that generate splashes
D. Washing hands with soap and water after removing gloves
E. Placing all clients in private rooms
F. Using dedicated equipment for each client
Correct Answers: A, B, C, D
Rationale: Standard precautions apply to all clients regardless of diagnosis. Gloves (A), gowns (B), and
mask/eye protection (C) are used based on anticipated exposure to blood or body fluids. Hand hygiene
after glove removal (D) is essential because gloves have microtears. Private rooms (E) are transmission-
based precautions, not standard precautions. Dedicated equipment (F) is for contact precautions, not
standard precautions.
Q4. A nurse witnesses a client fall in the bathroom. After ensuring the client is safe, which action should
the nurse take next?
A. Complete the incident report before the end of the shift
B. Document the fall in the client's medical record
C. Notify the provider and family immediately
D. Reassess the client for injuries and vital signs
Correct Answer: D
Rationale: After ensuring immediate safety, the nurse must reassess the client for injuries (head trauma,
fractures, lacerations) and obtain vital signs to detect internal bleeding or shock. This follows the nursing
process: assessment comes before documentation, reporting, or notification. While incident reports (A)
and provider notification (C) are important, they follow the assessment that determines the urgency and
nature of injuries. Documentation (B) should be objective and factual, completed after assessment and
interventions.
,Q5. [ORDERED RESPONSE – PRIORITY] A fire breaks out in a client's room. Place the nurse's actions in
the correct order using the RACE protocol.
1. Activate the fire alarm and call the hospital operator
2. Confine the fire by closing doors and windows
3. Evacuate clients from the immediate area
4. Extinguish the fire if small and contained, using PASS technique
Correct Answer: 1, 3, 2, 4
Rationale: RACE stands for Rescue, Alarm, Confine, Extinguish. First, rescue (evacuate) clients from
immediate danger (3). Then activate the alarm (1) to alert others and summon help. Confine the fire (2)
by closing doors and windows to limit oxygen and slow spread. Extinguish (4) only if the fire is small,
contained, and the nurse has a clear exit—never risk becoming trapped. This sequence prioritizes life
safety over property, following fire safety protocols for healthcare facilities.
Q6. A nurse is caring for a client who requires wrist restraints to prevent removal of a nasogastric tube.
Which nursing action is required by The Joint Commission?
A. Remove the restraints every 4 hours for range-of-motion exercises
B. Obtain a provider's order for restraints within 1 hour of application
C. Document the client's behavior every 15 minutes while in restraints
D. Release the restraints every 2 hours for toileting and meals
Correct Answer: B
Rationale: The Joint Commission requires a provider's order for restraints within 1 hour of application
for non-violent behavior (such as medical device removal). The order must specify the type of restraint,
reason, and duration. While ROM exercises (A), frequent documentation (C), and release for care (D) are
good practices, the 1-hour provider order is the specific regulatory requirement. Restraints are a last
resort after less restrictive alternatives have been attempted, and the nurse must reassess the need for
continued restraints regularly.
Q7. [DELEGATION TO UAP/LPN] A nurse is caring for a client who is on fall precautions. Which task is
appropriate to delegate to the UAP?
A. Assessing the client's risk for falls using the Morse Fall Scale
B. Keeping the call light within reach and ensuring the bed is in the lowest position
C. Teaching the client and family about fall prevention strategies
D. Evaluating the effectiveness of fall precaution interventions
, Correct Answer: B
Rationale: Keeping the call light within reach and the bed in the lowest position are task-oriented
interventions within UAP scope—environmental safety measures that prevent falls. Assessing fall risk (A)
requires nursing judgment and use of validated tools. Teaching (C) requires education skills and
knowledge of fall prevention principles. Evaluating effectiveness (D) is nursing assessment. The UAP
implements the environmental components of the fall prevention plan while the nurse manages
assessment, education, and evaluation.
Q8. A nurse sustains a needlestick injury while drawing blood from a client with unknown HIV status.
Which action should the nurse take first?
A. Complete the incident report and notify employee health
B. Wash the puncture site with soap and water
C. Squeeze the wound to express blood
D. Apply pressure and a bandage to the wound
Correct Answer: B
Rationale: Immediate washing with soap and water is the first and most important step after a
needlestick. This mechanical action removes contaminated blood and reduces viral load exposure.
Squeezing the wound (C) is no longer recommended as it may increase tissue damage and viral entry.
Pressure and bandage (D) follow washing. Incident reporting (A) is essential but does not take
precedence over immediate first aid. The nurse should then report to employee health for risk
assessment, baseline testing, and potential post-exposure prophylaxis within 2 hours.
Q9. [SELECT ALL THAT APPLY] A nurse is preparing to enter the room of a client with airborne
precautions for tuberculosis. Which PPE is required? (Select all that apply.)
A. N95 respirator or powered air-purifying respirator (PAPR)
B. Gloves
C. Gown
D. Face shield
E. Surgical mask
F. Shoe covers
Correct Answers: A, B
Rationale: Airborne precautions require an N95 respirator (A) because tuberculosis bacilli are
transmitted via droplet nuclei (<5 microns) that remain suspended in air. Gloves (B) are part of standard
precautions and should be worn when touching the client or environment. Gowns (C) are for contact
precautions or when there is risk of soiling. Face shields (D) protect against splashes. Surgical masks (E)
do not filter airborne particles and are not sufficient for TB. Shoe covers (F) are not part of standard
