NU 301 Unit 7 Exam (PDF) | (Updated) NCLEX-Style
Fundamentals of Nursing Questions — 200 Questions and
Answers Already Graded A+ Premium Exam Tested And
Verified
Subject Area Fundamentals of Nursing
Description This exam assesses advanced understanding of nursing fundamentals including
fluid and electrolyte balance, acid-base disorders, perioperative care, wound
healing, infection control, pain management, and ethical-legal principles.
Questions are designed to test clinical reasoning, application of evidence-based
practice, and integration of pathophysiology with nursing interventions.
Expected Grade A+
Total Questions 200
Duration 3 hours
Learning Outcomes 1. Analyze complex fluid and electrolyte imbalances and prioritize nursing
interventions.
2. Evaluate perioperative care plans incorporating patient safety and
evidence-based protocols.
3. Synthesize principles of wound healing and infection control in chronic wound
management.
4. Apply ethical-legal frameworks to dilemmas in end-of-life care and patient
autonomy.
Accreditation Accredited by the Commission on Collegiate Nursing Education (CCNE) and
aligns with NCLEX-RN test plan standards.
Page 1
,1. A patient with chronic kidney disease stage 5 has a serum potassium of 6.8 mEq/L
and an ECG showing peaked T waves. The nurse is preparing to administer
intravenous calcium gluconate. Which mechanism best explains why calcium
gluconate is administered before other interventions?
A. It directly lowers serum potassium by shifting potassium into cells.
B. It antagonizes the cardiac effects of hyperkalemia by stabilizing the myocardial cell
membrane.
C. It chelates potassium in the bloodstream, facilitating renal excretion.
D. It stimulates aldosterone release, increasing potassium excretion by the kidneys.
Answer: B. It antagonizes the cardiac effects of hyperkalemia by stabilizing the
myocardial cell membrane.
Calcium gluconate does not lower serum potassium; it protects the heart by raising the
threshold for action potentials, thereby reducing the risk of ventricular fibrillation. It
acts as a membrane stabilizer. Option A describes the effect of insulin and glucose or
beta-agonists. Option C is incorrect because calcium does not chelate potassium. Option
D is not an immediate effect; aldosterone takes longer to act.
2. A postoperative patient develops sudden dyspnea, pleuritic chest pain, and
hemoptysis. Vital signs: HR 112, BP 90/60, RR 28, SpO2 88% on room air. The
nurse suspects a pulmonary embolism. Which assessment finding would most
strongly support this diagnosis and differentiate it from other causes?
A. Elevated D-dimer and positive CT pulmonary angiography.
B. Bilateral crackles on lung auscultation and frothy sputum.
C. ST-segment elevation on ECG and elevated cardiac troponin.
D. Fever and purulent sputum with consolidation on chest X-ray.
Answer: A. Elevated D-dimer and positive CT pulmonary angiography.
A positive CT pulmonary angiography is the gold standard for diagnosing pulmonary
embolism, and elevated D-dimer supports the need for imaging. Option B suggests
pulmonary edema. Option C suggests myocardial infarction. Option D suggests
pneumonia. The triad of dyspnea, chest pain, and hemoptysis with hypoxia is classic for
PE, but confirmatory imaging is required.
Page 2
,3. A nurse is caring for a patient receiving mechanical ventilation with a closed
suction system. Which action best reduces the risk of ventilator-associated
pneumonia (VAP) while performing endotracheal suctioning?
A. Instill 5 mL of normal saline into the endotracheal tube before suctioning to loosen
secretions.
B. Use a new sterile suction catheter for each suctioning episode, even with closed system.
C. Maintain the patient in a semi-recumbent position (30-45 degrees) and perform suctioning
only when clinically indicated.
D. Perform routine suctioning every 2 hours regardless of secretions to keep airway clear.
Answer: C. Maintain the patient in a semi-recumbent position (30-45 degrees) and
perform suctioning only when clinically indicated.
Evidence-based guidelines for VAP prevention include elevating the head of the bed to
30-45 degrees and avoiding routine suctioning; suction only when needed based on
assessment. Routine instillation of saline is not recommended as it may increase
infection risk. Closed suction systems allow reuse of the catheter for 24 hours, so a new
catheter each time is unnecessary and wasteful.
4. A nurse is assessing a patient with a pressure injury on the sacrum. The wound
has full-thickness tissue loss with visible subcutaneous fat but no exposed bone,
tendon, or muscle. The wound bed is viable, with some slough. How should this
pressure injury be staged according to the National Pressure Injury Advisory Panel
(NPIAP) guidelines?
A. Stage 2 pressure injury.
B. Stage 3 pressure injury.
C. Stage 4 pressure injury.
D. Unstageable pressure injury.
Answer: B. Stage 3 pressure injury.
A stage 3 pressure injury involves full-thickness skin loss with visible subcutaneous fat;
slough may be present but does not obscure the depth. Stage 2 is partial-thickness.
Stage 4 involves exposed bone, tendon, or muscle. Unstageable is when the wound base
is obscured by slough or eschar. This description matches stage 3.
Page 3
, 5. A patient with a history of chronic obstructive pulmonary disease (COPD) is
admitted with an acute exacerbation. Arterial blood gas results: pH 7.32, PaCO2 60
mm Hg, PaO2 55 mm Hg, HCO3- 28 mEq/L. The nurse interprets these findings.
Which acid-base imbalance is present, and what is the most likely compensatory
response?
A. Acute respiratory acidosis with no compensation; the kidneys have not had time to retain
bicarbonate.
B. Chronic respiratory acidosis with metabolic compensation; the elevated bicarbonate
indicates renal retention.
C. Metabolic alkalosis with respiratory compensation; the elevated PaCO2 is compensating
for the alkalosis.
D. Combined respiratory and metabolic acidosis; both PaCO2 and HCO3- are elevated.
Answer: B. Chronic respiratory acidosis with metabolic compensation; the
elevated bicarbonate indicates renal retention.
The pH is low (acidemia), PaCO2 is high (respiratory acidosis), and HCO3- is elevated
(28 mEq/L, above normal 24). In chronic respiratory acidosis, the kidneys compensate
by retaining bicarbonate to normalize pH. The elevated HCO3- suggests compensation
has occurred over days. Acute respiratory acidosis would have normal HCO3-.
6. A nurse is administering a blood transfusion to a patient. After 15 minutes, the
patient reports lower back pain and appears anxious. Vital signs: BP 80/50, HR 110,
temperature 37.2°C. The nurse notes dark red urine in the urinary catheter bag.
What is the priority nursing action?
A. Increase the IV flow rate of normal saline and administer an antipyretic.
B. Stop the transfusion immediately and maintain IV access with normal saline.
C. Administer diphenhydramine intramuscularly and continue the transfusion at a slower
rate.
D. Obtain a blood culture and start broad-spectrum antibiotics.
Answer: B. Stop the transfusion immediately and maintain IV access with normal
saline.
Lower back pain, hypotension, anxiety, and dark urine indicate an acute hemolytic
transfusion reaction. Immediate cessation of the transfusion is critical to minimize
further hemolysis. IV access is maintained for emergency medications. Option A is
incorrect because stopping the transfusion is priority; antipyretics are for febrile
reactions. Option C describes managing an allergic reaction. Option D is for suspected
bacterial contamination.
Page 4
Fundamentals of Nursing Questions — 200 Questions and
Answers Already Graded A+ Premium Exam Tested And
Verified
Subject Area Fundamentals of Nursing
Description This exam assesses advanced understanding of nursing fundamentals including
fluid and electrolyte balance, acid-base disorders, perioperative care, wound
healing, infection control, pain management, and ethical-legal principles.
Questions are designed to test clinical reasoning, application of evidence-based
practice, and integration of pathophysiology with nursing interventions.
Expected Grade A+
Total Questions 200
Duration 3 hours
Learning Outcomes 1. Analyze complex fluid and electrolyte imbalances and prioritize nursing
interventions.
2. Evaluate perioperative care plans incorporating patient safety and
evidence-based protocols.
3. Synthesize principles of wound healing and infection control in chronic wound
management.
4. Apply ethical-legal frameworks to dilemmas in end-of-life care and patient
autonomy.
Accreditation Accredited by the Commission on Collegiate Nursing Education (CCNE) and
aligns with NCLEX-RN test plan standards.
Page 1
,1. A patient with chronic kidney disease stage 5 has a serum potassium of 6.8 mEq/L
and an ECG showing peaked T waves. The nurse is preparing to administer
intravenous calcium gluconate. Which mechanism best explains why calcium
gluconate is administered before other interventions?
A. It directly lowers serum potassium by shifting potassium into cells.
B. It antagonizes the cardiac effects of hyperkalemia by stabilizing the myocardial cell
membrane.
C. It chelates potassium in the bloodstream, facilitating renal excretion.
D. It stimulates aldosterone release, increasing potassium excretion by the kidneys.
Answer: B. It antagonizes the cardiac effects of hyperkalemia by stabilizing the
myocardial cell membrane.
Calcium gluconate does not lower serum potassium; it protects the heart by raising the
threshold for action potentials, thereby reducing the risk of ventricular fibrillation. It
acts as a membrane stabilizer. Option A describes the effect of insulin and glucose or
beta-agonists. Option C is incorrect because calcium does not chelate potassium. Option
D is not an immediate effect; aldosterone takes longer to act.
2. A postoperative patient develops sudden dyspnea, pleuritic chest pain, and
hemoptysis. Vital signs: HR 112, BP 90/60, RR 28, SpO2 88% on room air. The
nurse suspects a pulmonary embolism. Which assessment finding would most
strongly support this diagnosis and differentiate it from other causes?
A. Elevated D-dimer and positive CT pulmonary angiography.
B. Bilateral crackles on lung auscultation and frothy sputum.
C. ST-segment elevation on ECG and elevated cardiac troponin.
D. Fever and purulent sputum with consolidation on chest X-ray.
Answer: A. Elevated D-dimer and positive CT pulmonary angiography.
A positive CT pulmonary angiography is the gold standard for diagnosing pulmonary
embolism, and elevated D-dimer supports the need for imaging. Option B suggests
pulmonary edema. Option C suggests myocardial infarction. Option D suggests
pneumonia. The triad of dyspnea, chest pain, and hemoptysis with hypoxia is classic for
PE, but confirmatory imaging is required.
Page 2
,3. A nurse is caring for a patient receiving mechanical ventilation with a closed
suction system. Which action best reduces the risk of ventilator-associated
pneumonia (VAP) while performing endotracheal suctioning?
A. Instill 5 mL of normal saline into the endotracheal tube before suctioning to loosen
secretions.
B. Use a new sterile suction catheter for each suctioning episode, even with closed system.
C. Maintain the patient in a semi-recumbent position (30-45 degrees) and perform suctioning
only when clinically indicated.
D. Perform routine suctioning every 2 hours regardless of secretions to keep airway clear.
Answer: C. Maintain the patient in a semi-recumbent position (30-45 degrees) and
perform suctioning only when clinically indicated.
Evidence-based guidelines for VAP prevention include elevating the head of the bed to
30-45 degrees and avoiding routine suctioning; suction only when needed based on
assessment. Routine instillation of saline is not recommended as it may increase
infection risk. Closed suction systems allow reuse of the catheter for 24 hours, so a new
catheter each time is unnecessary and wasteful.
4. A nurse is assessing a patient with a pressure injury on the sacrum. The wound
has full-thickness tissue loss with visible subcutaneous fat but no exposed bone,
tendon, or muscle. The wound bed is viable, with some slough. How should this
pressure injury be staged according to the National Pressure Injury Advisory Panel
(NPIAP) guidelines?
A. Stage 2 pressure injury.
B. Stage 3 pressure injury.
C. Stage 4 pressure injury.
D. Unstageable pressure injury.
Answer: B. Stage 3 pressure injury.
A stage 3 pressure injury involves full-thickness skin loss with visible subcutaneous fat;
slough may be present but does not obscure the depth. Stage 2 is partial-thickness.
Stage 4 involves exposed bone, tendon, or muscle. Unstageable is when the wound base
is obscured by slough or eschar. This description matches stage 3.
Page 3
, 5. A patient with a history of chronic obstructive pulmonary disease (COPD) is
admitted with an acute exacerbation. Arterial blood gas results: pH 7.32, PaCO2 60
mm Hg, PaO2 55 mm Hg, HCO3- 28 mEq/L. The nurse interprets these findings.
Which acid-base imbalance is present, and what is the most likely compensatory
response?
A. Acute respiratory acidosis with no compensation; the kidneys have not had time to retain
bicarbonate.
B. Chronic respiratory acidosis with metabolic compensation; the elevated bicarbonate
indicates renal retention.
C. Metabolic alkalosis with respiratory compensation; the elevated PaCO2 is compensating
for the alkalosis.
D. Combined respiratory and metabolic acidosis; both PaCO2 and HCO3- are elevated.
Answer: B. Chronic respiratory acidosis with metabolic compensation; the
elevated bicarbonate indicates renal retention.
The pH is low (acidemia), PaCO2 is high (respiratory acidosis), and HCO3- is elevated
(28 mEq/L, above normal 24). In chronic respiratory acidosis, the kidneys compensate
by retaining bicarbonate to normalize pH. The elevated HCO3- suggests compensation
has occurred over days. Acute respiratory acidosis would have normal HCO3-.
6. A nurse is administering a blood transfusion to a patient. After 15 minutes, the
patient reports lower back pain and appears anxious. Vital signs: BP 80/50, HR 110,
temperature 37.2°C. The nurse notes dark red urine in the urinary catheter bag.
What is the priority nursing action?
A. Increase the IV flow rate of normal saline and administer an antipyretic.
B. Stop the transfusion immediately and maintain IV access with normal saline.
C. Administer diphenhydramine intramuscularly and continue the transfusion at a slower
rate.
D. Obtain a blood culture and start broad-spectrum antibiotics.
Answer: B. Stop the transfusion immediately and maintain IV access with normal
saline.
Lower back pain, hypotension, anxiety, and dark urine indicate an acute hemolytic
transfusion reaction. Immediate cessation of the transfusion is critical to minimize
further hemolysis. IV access is maintained for emergency medications. Option A is
incorrect because stopping the transfusion is priority; antipyretics are for febrile
reactions. Option C describes managing an allergic reaction. Option D is for suspected
bacterial contamination.
Page 4
