NR-224 Fundamentals of Nursing Comprehensive Examination III:
Advanced Prioritization, Delegation, Clinical Judgment, Safety Science,
Hygiene, Mobility, Infection Prevention, and Patient Advocacy Across
Care Settings
150 Multiple-Choice Questions with Correct Answers and Rationales
Section 1: Vital Signs & Assessment (Questions 1–25)
1. A nurse assesses a patient’s blood pressure using a cuff that is too small for the patient’s arm circumference. How
will this affect the reading?
• A) Falsely low systolic and diastolic
• B) Falsely high systolic and diastolic
• C) Falsely low systolic, high diastolic
• D) No significant effect
Correct Answer: B – A cuff that is too small (undercuffing) requires higher pressure to occlude the artery, resulting in
falsely elevated readings.
2. A patient’s temperature via temporal artery is 99.8°F (37.7°C). The patient has a history of sweating from recent
exercise. Which action is most accurate?
• A) Document as febrile
• B) Wait 15 minutes after cooling down to reassess
• C) Use an oral thermometer for confirmation
• D) Apply alcohol to forehead and remeasure
Correct Answer: B – Temporal artery readings can be affected by sweating, vasodilation, or recent cooling. Wait for
equilibration.
3. A nurse assesses a patient’s radial pulse and finds it is 2+ and regular. The patient is on a beta-blocker. What does 2+
indicate?
• A) Absent
• B) Diminished
• C) Normal
• D) Bounding
Correct Answer: C – Pulse amplitude scale: 0 absent, 1+ diminished/weak, 2+ normal, 3+ full/increased, 4+
bounding.
4. A patient’s respiratory rate is 30 breaths/minute with deep, gasping breaths. The patient is unresponsive. The nurse
should:
• A) Apply oxygen via non-rebreather
• B) Check for a pulse and begin CPR if absent
• C) Place in recovery position
• D) Administer naloxone
Correct Answer: B – Gasping (agonal breathing) is not effective breathing. Check pulse; if no pulse or uncertain,
,begin CPR. Agonal breathing is a sign of cardiac arrest.
5. A patient’s oxygen saturation is 95% on 2 L nasal cannula. The nurse titrates down to 1 L. Fifteen minutes later, SpO2
is 90%. The patient is not in distress. The nurse should:
• A) Return to 2 L
• B) Leave at 1 L; 90% is acceptable
• C) Increase to 3 L
• D) Obtain an ABG
Correct Answer: A – Return to previous effective FiO2. SpO2 <92% on room air or reduced O2 indicates continued
need. 90% is borderline and not goal for most patients.
6. A nurse assesses a patient’s blood pressure as 100/60 mm Hg. The patient’s baseline is 140/90. The patient is dizzy
and pale. The nurse should first:
• A) Lay the patient flat with legs elevated
• B) Administer a fluid bolus
• C) Notify the provider
• D) Recheck BP in 5 minutes
Correct Answer: A – Trendelenburg or supine with leg elevation improves preload and cerebral perfusion. Then
reassess, notify provider.
7. A patient’s apical pulse is auscultated as 110 bpm and irregularly irregular with no discernible P waves on the
monitor. The nurse recognizes this rhythm as:
• A) Sinus tachycardia
• B) Atrial fibrillation
• C) Atrial flutter
• D) Multifocal atrial tachycardia
Correct Answer: B – Atrial fibrillation: irregularly irregular rhythm, no P waves. Atrial flutter has sawtooth waves.
Sinus tachycardia has P waves.
8. A patient has a fever of 104°F (40°C). The nurse administers acetaminophen and initiates cooling measures. Which
finding indicates a positive response?
• A) Shivering
• B) Decrease in temperature by 1°F in 1 hour
• C) Heart rate increase to 130 bpm
• D) Patient reports feeling cold
Correct Answer: B – Goal is temperature reduction of 0.5-1°C (1-2°F) per hour. Shivering indicates heat production,
not cooling.
9. A nurse is unable to obtain a blood pressure reading on a patient in shock. The nurse should next:
• A) Use a Doppler and manual cuff
• B) Estimate systolic by palpation
• C) Insert an arterial line
• D) Assume BP is adequate if radial pulse palpable
Correct Answer: A – Doppler amplifies Korotkoff sounds in low-flow states. Palpated systolic (by palpatory method)
is less accurate but can be used if Doppler unavailable.
10. A patient’s SpO2 is 90% on room air. The nurse applies 2 L oxygen and SpO2 rises to 98%. The patient has a history
, of COPD with baseline SpO2 88-90% on room air. The patient becomes confused. The nurse should:
• A) Continue 2 L; confusion is unrelated
• B) Reduce oxygen to 1 L and notify provider (possible CO2 retention)
• C) Increase oxygen to 4 L
• D) Intubate for airway protection
Correct Answer: B – COPD patients may have chronic hypoxemia and hypercapnia. Overshooting SpO2 (>92-94%)
can worsen CO2 retention. Target SpO2 88-92% in COPD.
11. A patient’s heart rate is 150 bpm and regular. The patient is alert, BP 110/70, and reports palpitations. The nurse
should first:
• A) Administer adenosine
• B) Ask patient to bear down (Valsalva)
• C) Prepare for synchronized cardioversion
• D) Obtain a 12-lead ECG
Correct Answer: B – Vagal maneuvers (Valsalva, carotid massage) may terminate supraventricular tachycardia. Use
before medications if patient stable.
12. The nurse notes a patient’s temperature is 95.5°F (35.3°C) tympanic. The patient is shivering and confused. The
priority is:
• A) Apply forced-air warming blanket
• B) Give warm oral fluids
• C) Increase room temperature
• D) Obtain a rectal temperature for accuracy
Correct Answer: A – Moderate hypothermia (<96°F/35.5°C) with confusion requires active rewarming (warm
blankets, warmed IV fluids). Shivering increases metabolic demand.
13. A patient’s respiratory rate is 22 breaths/minute and shallow. The patient had abdominal surgery yesterday and is
on patient-controlled analgesia (PCA) with morphine. The nurse should:
• A) Decrease PCA dose
• B) Encourage incentive spirometry and assess pain/sedation
• C) Administer naloxone
• D) Apply oxygen only
Correct Answer: B – Tachypnea with shallow breathing suggests splinting or atelectasis, not opioid overdose (which
causes bradypnea). Incentive spirometry and pain control improve depth.
14. A nurse assesses a patient’s blood pressure in both arms: right arm 158/92, left arm 120/70. The patient reports no
symptoms. What is the priority action?
• A) Use the right arm for all future readings
• B) Document as normal variant
• C) Repeat in 5 minutes; if persists, notify provider
• D) Assume right arm is accurate
Correct Answer: C – A difference >10-15 mm Hg systolic may indicate subclavian stenosis or aortic dissection.
Repeat; if persistent, notify provider for further evaluation.
15. A patient’s pulse oximeter reading is 88% but the patient is alert, has pink mucous membranes, and reports no
dyspnea. The nurse should first:
Advanced Prioritization, Delegation, Clinical Judgment, Safety Science,
Hygiene, Mobility, Infection Prevention, and Patient Advocacy Across
Care Settings
150 Multiple-Choice Questions with Correct Answers and Rationales
Section 1: Vital Signs & Assessment (Questions 1–25)
1. A nurse assesses a patient’s blood pressure using a cuff that is too small for the patient’s arm circumference. How
will this affect the reading?
• A) Falsely low systolic and diastolic
• B) Falsely high systolic and diastolic
• C) Falsely low systolic, high diastolic
• D) No significant effect
Correct Answer: B – A cuff that is too small (undercuffing) requires higher pressure to occlude the artery, resulting in
falsely elevated readings.
2. A patient’s temperature via temporal artery is 99.8°F (37.7°C). The patient has a history of sweating from recent
exercise. Which action is most accurate?
• A) Document as febrile
• B) Wait 15 minutes after cooling down to reassess
• C) Use an oral thermometer for confirmation
• D) Apply alcohol to forehead and remeasure
Correct Answer: B – Temporal artery readings can be affected by sweating, vasodilation, or recent cooling. Wait for
equilibration.
3. A nurse assesses a patient’s radial pulse and finds it is 2+ and regular. The patient is on a beta-blocker. What does 2+
indicate?
• A) Absent
• B) Diminished
• C) Normal
• D) Bounding
Correct Answer: C – Pulse amplitude scale: 0 absent, 1+ diminished/weak, 2+ normal, 3+ full/increased, 4+
bounding.
4. A patient’s respiratory rate is 30 breaths/minute with deep, gasping breaths. The patient is unresponsive. The nurse
should:
• A) Apply oxygen via non-rebreather
• B) Check for a pulse and begin CPR if absent
• C) Place in recovery position
• D) Administer naloxone
Correct Answer: B – Gasping (agonal breathing) is not effective breathing. Check pulse; if no pulse or uncertain,
,begin CPR. Agonal breathing is a sign of cardiac arrest.
5. A patient’s oxygen saturation is 95% on 2 L nasal cannula. The nurse titrates down to 1 L. Fifteen minutes later, SpO2
is 90%. The patient is not in distress. The nurse should:
• A) Return to 2 L
• B) Leave at 1 L; 90% is acceptable
• C) Increase to 3 L
• D) Obtain an ABG
Correct Answer: A – Return to previous effective FiO2. SpO2 <92% on room air or reduced O2 indicates continued
need. 90% is borderline and not goal for most patients.
6. A nurse assesses a patient’s blood pressure as 100/60 mm Hg. The patient’s baseline is 140/90. The patient is dizzy
and pale. The nurse should first:
• A) Lay the patient flat with legs elevated
• B) Administer a fluid bolus
• C) Notify the provider
• D) Recheck BP in 5 minutes
Correct Answer: A – Trendelenburg or supine with leg elevation improves preload and cerebral perfusion. Then
reassess, notify provider.
7. A patient’s apical pulse is auscultated as 110 bpm and irregularly irregular with no discernible P waves on the
monitor. The nurse recognizes this rhythm as:
• A) Sinus tachycardia
• B) Atrial fibrillation
• C) Atrial flutter
• D) Multifocal atrial tachycardia
Correct Answer: B – Atrial fibrillation: irregularly irregular rhythm, no P waves. Atrial flutter has sawtooth waves.
Sinus tachycardia has P waves.
8. A patient has a fever of 104°F (40°C). The nurse administers acetaminophen and initiates cooling measures. Which
finding indicates a positive response?
• A) Shivering
• B) Decrease in temperature by 1°F in 1 hour
• C) Heart rate increase to 130 bpm
• D) Patient reports feeling cold
Correct Answer: B – Goal is temperature reduction of 0.5-1°C (1-2°F) per hour. Shivering indicates heat production,
not cooling.
9. A nurse is unable to obtain a blood pressure reading on a patient in shock. The nurse should next:
• A) Use a Doppler and manual cuff
• B) Estimate systolic by palpation
• C) Insert an arterial line
• D) Assume BP is adequate if radial pulse palpable
Correct Answer: A – Doppler amplifies Korotkoff sounds in low-flow states. Palpated systolic (by palpatory method)
is less accurate but can be used if Doppler unavailable.
10. A patient’s SpO2 is 90% on room air. The nurse applies 2 L oxygen and SpO2 rises to 98%. The patient has a history
, of COPD with baseline SpO2 88-90% on room air. The patient becomes confused. The nurse should:
• A) Continue 2 L; confusion is unrelated
• B) Reduce oxygen to 1 L and notify provider (possible CO2 retention)
• C) Increase oxygen to 4 L
• D) Intubate for airway protection
Correct Answer: B – COPD patients may have chronic hypoxemia and hypercapnia. Overshooting SpO2 (>92-94%)
can worsen CO2 retention. Target SpO2 88-92% in COPD.
11. A patient’s heart rate is 150 bpm and regular. The patient is alert, BP 110/70, and reports palpitations. The nurse
should first:
• A) Administer adenosine
• B) Ask patient to bear down (Valsalva)
• C) Prepare for synchronized cardioversion
• D) Obtain a 12-lead ECG
Correct Answer: B – Vagal maneuvers (Valsalva, carotid massage) may terminate supraventricular tachycardia. Use
before medications if patient stable.
12. The nurse notes a patient’s temperature is 95.5°F (35.3°C) tympanic. The patient is shivering and confused. The
priority is:
• A) Apply forced-air warming blanket
• B) Give warm oral fluids
• C) Increase room temperature
• D) Obtain a rectal temperature for accuracy
Correct Answer: A – Moderate hypothermia (<96°F/35.5°C) with confusion requires active rewarming (warm
blankets, warmed IV fluids). Shivering increases metabolic demand.
13. A patient’s respiratory rate is 22 breaths/minute and shallow. The patient had abdominal surgery yesterday and is
on patient-controlled analgesia (PCA) with morphine. The nurse should:
• A) Decrease PCA dose
• B) Encourage incentive spirometry and assess pain/sedation
• C) Administer naloxone
• D) Apply oxygen only
Correct Answer: B – Tachypnea with shallow breathing suggests splinting or atelectasis, not opioid overdose (which
causes bradypnea). Incentive spirometry and pain control improve depth.
14. A nurse assesses a patient’s blood pressure in both arms: right arm 158/92, left arm 120/70. The patient reports no
symptoms. What is the priority action?
• A) Use the right arm for all future readings
• B) Document as normal variant
• C) Repeat in 5 minutes; if persists, notify provider
• D) Assume right arm is accurate
Correct Answer: C – A difference >10-15 mm Hg systolic may indicate subclavian stenosis or aortic dissection.
Repeat; if persistent, notify provider for further evaluation.
15. A patient’s pulse oximeter reading is 88% but the patient is alert, has pink mucous membranes, and reports no
dyspnea. The nurse should first:
