NU 301 Unit 2 Exam (PDF) | (Updated) NCLEX-Style
Fundamentals of Nursing Questions — 180 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
critical thinking, evidence-based practice, patient safety, pharmacology, and
ethical-legal principles. Questions are designed at the level of NCLEX-RN and
top US university nursing programs.
Expected Grade A+
Total Questions 180
Duration 3 hours
Learning Outcomes 1. Apply nursing process and clinical judgment in complex patient scenarios
2. Integrate evidence-based practice with patient-centered care
3. Analyze ethical and legal dimensions of nursing interventions
4. Evaluate pharmacological and physiological responses to treatments
Accreditation Conforms to AACN Essentials and NCLEX-RN test plan standards
Page 1
,1. A patient with a history of chronic kidney disease (stage 4) is admitted with
hyperkalemia (K+ 6.2 mEq/L) and ECG changes (peaked T waves). The nurse notes
that the patient is on lisinopril, spironolactone, and furosemide. Which intervention
should the nurse question first?
A. Administer intravenous calcium gluconate
B. Hold the spironolactone
C. Administer sodium polystyrene sulfonate
D. Increase the furosemide dose
Answer: B. Hold the spironolactone
Spironolactone is a potassium-sparing diuretic; in the setting of hyperkalemia and
CKD, holding it is the priority to prevent further potassium elevation. Calcium
gluconate stabilizes cardiac membranes, SPS removes potassium slowly, and increasing
furosemide may be beneficial but not the first action.
2. A nurse is preparing to administer a blood transfusion to a patient with a history
of multiple transfusions. The patient's type and screen shows antibody to anti-Kell.
Which action is most critical before starting the transfusion?
A. Ensure the blood is crossmatched for Kell-negative units
B. Premedicate with diphenhydramine and acetaminophen
C. Obtain a signed consent for transfusion
D. Verify the patient's identity with two identifiers
Answer: A. Ensure the blood is crossmatched for Kell-negative units
Anti-Kell can cause severe hemolytic transfusion reactions. The most critical action is to
provide Kell-negative blood to prevent antigen-antibody reaction. Premedication and
consent are important but secondary to preventing hemolysis.
Page 2
,3. A nurse is assessing a patient who has been receiving IV heparin for deep vein
thrombosis. The aPTT is 90 seconds (control 30 seconds). The patient reports new
onset of severe headache and blurred vision. What should the nurse do first?
A. Administer vitamin K intramuscularly
B. Hold heparin and call the provider immediately
C. Administer protamine sulfate per protocol
D. Obtain a stat CT scan of the head
Answer: B. Hold heparin and call the provider immediately
Symptoms suggest possible intracranial hemorrhage. The priority is to stop the heparin
to prevent further bleeding. Protamine sulfate is the antidote but should be given after
consulting the provider. Vitamin K reverses warfarin, not heparin.
4. A patient with a pressure ulcer on the sacrum is being treated with a hydrocolloid
dressing. During a dressing change, the nurse observes that the wound bed has a foul
odor and greenish exudate. What is the nurse's priority action?
A. Apply a silver-impregnated dressing
B. Obtain a wound culture before cleansing
C. Irrigate the wound with normal saline
D. Notify the provider of suspected infection
Answer: B. Obtain a wound culture before cleansing
Obtaining a wound culture before cleansing ensures accurate identification of the
infecting organism. After culture, the wound can be cleansed and appropriate
antimicrobial dressings applied. Notifying the provider is important but the culture is
needed first.
5. A nurse is teaching a patient with newly diagnosed heart failure about fluid
restriction. The patient is prescribed furosemide 40 mg IV daily. Which statement by
the patient indicates a need for further teaching?
A. I should weigh myself every morning after urinating
B. I can drink as much water as I want if I take my diuretic
C. I will limit my sodium intake to less than 2 grams per day
D. I need to report a weight gain of 2 pounds in a day
Answer: B. I can drink as much water as I want if I take my diuretic
Patients with heart failure must restrict fluid intake even when taking diuretics.
Diuretics help remove excess fluid but do not allow unrestricted intake. Weighing daily,
limiting sodium, and reporting weight gain are correct behaviors.
Page 3
, 6. A nurse is evaluating a patient's arterial blood gas results: pH 7.32, PaCO2 48 mm
Hg, HCO3- 24 mEq/L. The nurse suspects which condition?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Answer: B. Respiratory acidosis
The pH is acidic (7.32) and PaCO2 is elevated (48), indicating respiratory acidosis.
HCO3- is normal, suggesting no metabolic compensation yet. Metabolic acidosis would
show low HCO3- and low pH. Alkalosis would show elevated pH.
7. A patient with a history of opioid use disorder is admitted for surgery. The nurse
is aware of the principles of pain management in this population. Which approach is
most appropriate?
A. Use non-opioid analgesics only to avoid triggering addiction
B. Administer opioids at higher doses due to tolerance
C. Provide patient-controlled analgesia with a basal rate
D. Avoid using naloxone even if respiratory depression occurs
Answer: C. Provide patient-controlled analgesia with a basal rate
PCA with a basal rate can provide consistent pain control while allowing the patient to
self-titrate. Tolerance may require higher doses, but the basal rate should be used
cautiously. Non-opioids alone are often insufficient. Naloxone should be used if needed.
8. A nurse is caring for a patient with a chest tube connected to a water seal drainage
system. The nurse notes continuous bubbling in the water seal chamber. What is the
most likely cause?
A. An air leak in the system
B. Normal tidaling with respiration
C. The suction is set too high
D. The drainage system is full
Answer: A. An air leak in the system
Continuous bubbling in the water seal chamber indicates an air leak, either from the
patient (e.g., bronchopleural fistula) or from a disconnection. Tidaling is intermittent
with breathing. Suction level affects the suction chamber, not the water seal.
Page 4
Fundamentals of Nursing Questions — 180 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
critical thinking, evidence-based practice, patient safety, pharmacology, and
ethical-legal principles. Questions are designed at the level of NCLEX-RN and
top US university nursing programs.
Expected Grade A+
Total Questions 180
Duration 3 hours
Learning Outcomes 1. Apply nursing process and clinical judgment in complex patient scenarios
2. Integrate evidence-based practice with patient-centered care
3. Analyze ethical and legal dimensions of nursing interventions
4. Evaluate pharmacological and physiological responses to treatments
Accreditation Conforms to AACN Essentials and NCLEX-RN test plan standards
Page 1
,1. A patient with a history of chronic kidney disease (stage 4) is admitted with
hyperkalemia (K+ 6.2 mEq/L) and ECG changes (peaked T waves). The nurse notes
that the patient is on lisinopril, spironolactone, and furosemide. Which intervention
should the nurse question first?
A. Administer intravenous calcium gluconate
B. Hold the spironolactone
C. Administer sodium polystyrene sulfonate
D. Increase the furosemide dose
Answer: B. Hold the spironolactone
Spironolactone is a potassium-sparing diuretic; in the setting of hyperkalemia and
CKD, holding it is the priority to prevent further potassium elevation. Calcium
gluconate stabilizes cardiac membranes, SPS removes potassium slowly, and increasing
furosemide may be beneficial but not the first action.
2. A nurse is preparing to administer a blood transfusion to a patient with a history
of multiple transfusions. The patient's type and screen shows antibody to anti-Kell.
Which action is most critical before starting the transfusion?
A. Ensure the blood is crossmatched for Kell-negative units
B. Premedicate with diphenhydramine and acetaminophen
C. Obtain a signed consent for transfusion
D. Verify the patient's identity with two identifiers
Answer: A. Ensure the blood is crossmatched for Kell-negative units
Anti-Kell can cause severe hemolytic transfusion reactions. The most critical action is to
provide Kell-negative blood to prevent antigen-antibody reaction. Premedication and
consent are important but secondary to preventing hemolysis.
Page 2
,3. A nurse is assessing a patient who has been receiving IV heparin for deep vein
thrombosis. The aPTT is 90 seconds (control 30 seconds). The patient reports new
onset of severe headache and blurred vision. What should the nurse do first?
A. Administer vitamin K intramuscularly
B. Hold heparin and call the provider immediately
C. Administer protamine sulfate per protocol
D. Obtain a stat CT scan of the head
Answer: B. Hold heparin and call the provider immediately
Symptoms suggest possible intracranial hemorrhage. The priority is to stop the heparin
to prevent further bleeding. Protamine sulfate is the antidote but should be given after
consulting the provider. Vitamin K reverses warfarin, not heparin.
4. A patient with a pressure ulcer on the sacrum is being treated with a hydrocolloid
dressing. During a dressing change, the nurse observes that the wound bed has a foul
odor and greenish exudate. What is the nurse's priority action?
A. Apply a silver-impregnated dressing
B. Obtain a wound culture before cleansing
C. Irrigate the wound with normal saline
D. Notify the provider of suspected infection
Answer: B. Obtain a wound culture before cleansing
Obtaining a wound culture before cleansing ensures accurate identification of the
infecting organism. After culture, the wound can be cleansed and appropriate
antimicrobial dressings applied. Notifying the provider is important but the culture is
needed first.
5. A nurse is teaching a patient with newly diagnosed heart failure about fluid
restriction. The patient is prescribed furosemide 40 mg IV daily. Which statement by
the patient indicates a need for further teaching?
A. I should weigh myself every morning after urinating
B. I can drink as much water as I want if I take my diuretic
C. I will limit my sodium intake to less than 2 grams per day
D. I need to report a weight gain of 2 pounds in a day
Answer: B. I can drink as much water as I want if I take my diuretic
Patients with heart failure must restrict fluid intake even when taking diuretics.
Diuretics help remove excess fluid but do not allow unrestricted intake. Weighing daily,
limiting sodium, and reporting weight gain are correct behaviors.
Page 3
, 6. A nurse is evaluating a patient's arterial blood gas results: pH 7.32, PaCO2 48 mm
Hg, HCO3- 24 mEq/L. The nurse suspects which condition?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Answer: B. Respiratory acidosis
The pH is acidic (7.32) and PaCO2 is elevated (48), indicating respiratory acidosis.
HCO3- is normal, suggesting no metabolic compensation yet. Metabolic acidosis would
show low HCO3- and low pH. Alkalosis would show elevated pH.
7. A patient with a history of opioid use disorder is admitted for surgery. The nurse
is aware of the principles of pain management in this population. Which approach is
most appropriate?
A. Use non-opioid analgesics only to avoid triggering addiction
B. Administer opioids at higher doses due to tolerance
C. Provide patient-controlled analgesia with a basal rate
D. Avoid using naloxone even if respiratory depression occurs
Answer: C. Provide patient-controlled analgesia with a basal rate
PCA with a basal rate can provide consistent pain control while allowing the patient to
self-titrate. Tolerance may require higher doses, but the basal rate should be used
cautiously. Non-opioids alone are often insufficient. Naloxone should be used if needed.
8. A nurse is caring for a patient with a chest tube connected to a water seal drainage
system. The nurse notes continuous bubbling in the water seal chamber. What is the
most likely cause?
A. An air leak in the system
B. Normal tidaling with respiration
C. The suction is set too high
D. The drainage system is full
Answer: A. An air leak in the system
Continuous bubbling in the water seal chamber indicates an air leak, either from the
patient (e.g., bronchopleural fistula) or from a disconnection. Tidaling is intermittent
with breathing. Suction level affects the suction chamber, not the water seal.
Page 4
