College of Nursing
4 MAXE SDNUF
★ ★
N Department of Health Sciences
SCIENTIA · CURA · COMPASSIO
EST. 1908
Fundamentals of Nursing — Examination 4
P H A R M A CO LO G Y · I N F E C T I O N CO N T R O L · D E L E G AT I O N · L E G A L · D O CU M E N TAT I O N
INSTITUTION College of Nursing COURSE CODE NURS 1101
PROGRAM Bachelor of Science in Nursing (BSN) ACADEMIC YEAR
EXAM TITLE Fundamentals of Nursing Exam 4 TOTAL QUESTIONS 60+ Questions
COURSE TITLE Nursing Fundamentals FORMAT Multiple Choice & Select All That Apply
EXAMINATION INSTRUCTIONS
▸ This comprehensive exam covers pharmacology (anticoagulants, antihypertensives, diuretics, analgesics), infection control,
delegation, legal principles, and documentation.
▸ Select the single best answer unless "Select all that apply" is indicated.
▸ Correct answers and clinical rationales appear below each question for NCLEX preparation.
SECTION I — PHARMACOLOGY: CARDIAC MEDICATIONS, Questions 1
ANTICOAGULANTS & ANALGESICS – 35
1. A client is scheduled for hydrotherapy for a burn dressing change. Which action should the nurse take to ensure
that the client is comfortable during the procedure?
1. Ensure that the client is appropriately dressed
2. Administer an opioid analgesic 30 to 60 minutes before therapy
3. Schedule the therapy at a time when the client generally takes a nap
4. Assign an assistive personnel (AP) to stay with the client during the procedure
CORRECT ANSWER 2 — Administer an opioid analgesic 30 to 60 minutes before therapy
RATIONALE The client should receive pain medication approximately 30 to 60 minutes before a burn dressing change.
This will help the client tolerate an otherwise painful procedure. None of the remaining options addresses
the issue of pain effectively.
2. The client with atrial fibrillation is prescribed sotalol AF. Which assessment finding indicates that the client is
experiencing an adverse effect of the medication?
1. Dry mouth
2. Diaphoresis
3. Difficulty swallowing
4. Dizziness and feeling faint
CORRECT ANSWER 4 — Dizziness and feeling faint
RATIONALE Sotalol AF is a beta-adrenergic blocking agent. Adverse effects include headache with chest pain and severe
dizziness, fainting, fast or pounding heartbeats. Options 1, 2, and 3 are not adverse effects of this
medication.
,3. The nurse is reviewing laboratory results for a client with chronic heart failure receiving torsemide 5 mg orally
daily. What value would indicate an adverse effect of the medication?
1. A chloride level of 98 mEq/L
2. A sodium level of 135 mEq/L
3. A potassium level of 3.1 mEq/L
4. A BUN level of 15 mg/dL
CORRECT ANSWER 3 — A potassium level of 3.1 mEq/L
RATIONALE Torsemide is a loop diuretic that can cause electrolyte depletion. Normal potassium is 3.5–5.0 mEq/L.
Options 1 (normal Cl- 98–107), 2 (normal Na+ 135–145), and 4 (normal BUN 10–20) are all within normal
limits.
4. A client with acute heart failure has BP 85/50, pulse 96, respirations 26. Digoxin is prescribed. Which vital sign
changes indicate a therapeutic response?
1. BP 85/50, pulse 60, respirations 26
2. BP 98/60, pulse 80, respirations 24
3. BP 130/70, pulse 104, respirations 20
4. BP 110/40, pulse 110, respirations 20
CORRECT ANSWER 2 — BP 98/60, pulse 80, respirations 24
RATIONALE Digoxin produces increased myocardial contractility (inotropic), raising BP. It also has a negative
chronotropic effect (decreases heart rate). As cardiac output improves, respirations should improve. Option
2 reflects these physiological changes.
5. A client with hypertension has been taking a calcium channel blocker for 2 months. Which finding indicates drug
tolerance has developed?
1. Decrease in weight
2. Increased joint pain
3. Output greater than intake
4. Gradual rise in blood pressure
CORRECT ANSWER 4 — Gradual rise in blood pressure
RATIONALE Drug tolerance to antihypertensives is evidenced by rising blood pressure levels. The provider may increase
dosage, change medication, or add a diuretic. Joint pain is not associated with this form of tolerance.
6. A client with angina is being treated with a beta-adrenergic blocker. Which assessment findings indicate dose-
related side effects? (Select all that apply.)
1. Dizziness
2. Bradycardia
3. Chest pain
4. Reflex tachycardia
5. Sexual dysfunction
6. Cardiac dysrhythmias
CORRECT ANSWER 1, 2, 5 — Dizziness, Bradycardia, Sexual dysfunction
RATIONALE Beta blocker side effects are usually dose-related and include dizziness (hypotension), bradycardia, and
sexual dysfunction (impotence). Chest pain, reflex tachycardia, and dysrhythmias are reasons for
prescribing beta blockers, not side effects.
, 7. A client with pulmonary congestion from heart failure received IV furosemide 40 mg. After an hour, which finding
indicates the therapy has been effective?
1. The lungs are now clear upon auscultation
2. The urine output has increased by 400 mL
3. The blood pressure has decreased from 118/64 to 106/62
4. The serum potassium has decreased from 4.7 to 4.1 mEq
CORRECT ANSWER 1 — The lungs are now clear upon auscultation
RATIONALE Furosemide was given to decrease preload and reduce pulmonary congestion. Although all options may
occur, clear lung sounds indicate the reason furosemide was administered — resolution of pulmonary
congestion.
8. A client with chronic kidney disease is scheduled for hemodialysis. When should the nurse administer the daily
dose of enalapril?
1. During dialysis
2. Just before dialysis
3. The day after dialysis
4. Upon return from dialysis
CORRECT ANSWER 4 — Upon return from dialysis
RATIONALE Antihypertensives like enalapril are given after hemodialysis to prevent hypotension during dialysis and to
prevent the medication from being removed by dialysis. Waiting a full day would lead to ineffective BP
control.
9. A nurse is caring for a client with a new prescription for captopril for hypertension. Which adverse effect should
the nurse monitor for?
a. Hypokalemia
b. Hypernatremia
c. Neutropenia
d. Bradycardia
CORRECT ANSWER c — Neutropenia
RATIONALE Neutropenia is a serious adverse effect of ACE inhibitors (captopril). Monitor CBC and teach the client to
report signs of infection. Hypokalemia, hypernatremia, and bradycardia are not adverse effects of ACE
inhibitors.
10. A client receiving continuous IV heparin begins to vomit blood. After stopping heparin, which medication should
the nurse administer?
a. Vitamin K
b. Atropine
c. Protamine
d. Calcium gluconate
CORRECT ANSWER c — Protamine
RATIONALE Protamine reverses the anticoagulant effect of heparin. Vitamin K reverses warfarin. Atropine reverses beta-
blocker bradycardia. Calcium gluconate treats magnesium sulfate toxicity.
4 MAXE SDNUF
★ ★
N Department of Health Sciences
SCIENTIA · CURA · COMPASSIO
EST. 1908
Fundamentals of Nursing — Examination 4
P H A R M A CO LO G Y · I N F E C T I O N CO N T R O L · D E L E G AT I O N · L E G A L · D O CU M E N TAT I O N
INSTITUTION College of Nursing COURSE CODE NURS 1101
PROGRAM Bachelor of Science in Nursing (BSN) ACADEMIC YEAR
EXAM TITLE Fundamentals of Nursing Exam 4 TOTAL QUESTIONS 60+ Questions
COURSE TITLE Nursing Fundamentals FORMAT Multiple Choice & Select All That Apply
EXAMINATION INSTRUCTIONS
▸ This comprehensive exam covers pharmacology (anticoagulants, antihypertensives, diuretics, analgesics), infection control,
delegation, legal principles, and documentation.
▸ Select the single best answer unless "Select all that apply" is indicated.
▸ Correct answers and clinical rationales appear below each question for NCLEX preparation.
SECTION I — PHARMACOLOGY: CARDIAC MEDICATIONS, Questions 1
ANTICOAGULANTS & ANALGESICS – 35
1. A client is scheduled for hydrotherapy for a burn dressing change. Which action should the nurse take to ensure
that the client is comfortable during the procedure?
1. Ensure that the client is appropriately dressed
2. Administer an opioid analgesic 30 to 60 minutes before therapy
3. Schedule the therapy at a time when the client generally takes a nap
4. Assign an assistive personnel (AP) to stay with the client during the procedure
CORRECT ANSWER 2 — Administer an opioid analgesic 30 to 60 minutes before therapy
RATIONALE The client should receive pain medication approximately 30 to 60 minutes before a burn dressing change.
This will help the client tolerate an otherwise painful procedure. None of the remaining options addresses
the issue of pain effectively.
2. The client with atrial fibrillation is prescribed sotalol AF. Which assessment finding indicates that the client is
experiencing an adverse effect of the medication?
1. Dry mouth
2. Diaphoresis
3. Difficulty swallowing
4. Dizziness and feeling faint
CORRECT ANSWER 4 — Dizziness and feeling faint
RATIONALE Sotalol AF is a beta-adrenergic blocking agent. Adverse effects include headache with chest pain and severe
dizziness, fainting, fast or pounding heartbeats. Options 1, 2, and 3 are not adverse effects of this
medication.
,3. The nurse is reviewing laboratory results for a client with chronic heart failure receiving torsemide 5 mg orally
daily. What value would indicate an adverse effect of the medication?
1. A chloride level of 98 mEq/L
2. A sodium level of 135 mEq/L
3. A potassium level of 3.1 mEq/L
4. A BUN level of 15 mg/dL
CORRECT ANSWER 3 — A potassium level of 3.1 mEq/L
RATIONALE Torsemide is a loop diuretic that can cause electrolyte depletion. Normal potassium is 3.5–5.0 mEq/L.
Options 1 (normal Cl- 98–107), 2 (normal Na+ 135–145), and 4 (normal BUN 10–20) are all within normal
limits.
4. A client with acute heart failure has BP 85/50, pulse 96, respirations 26. Digoxin is prescribed. Which vital sign
changes indicate a therapeutic response?
1. BP 85/50, pulse 60, respirations 26
2. BP 98/60, pulse 80, respirations 24
3. BP 130/70, pulse 104, respirations 20
4. BP 110/40, pulse 110, respirations 20
CORRECT ANSWER 2 — BP 98/60, pulse 80, respirations 24
RATIONALE Digoxin produces increased myocardial contractility (inotropic), raising BP. It also has a negative
chronotropic effect (decreases heart rate). As cardiac output improves, respirations should improve. Option
2 reflects these physiological changes.
5. A client with hypertension has been taking a calcium channel blocker for 2 months. Which finding indicates drug
tolerance has developed?
1. Decrease in weight
2. Increased joint pain
3. Output greater than intake
4. Gradual rise in blood pressure
CORRECT ANSWER 4 — Gradual rise in blood pressure
RATIONALE Drug tolerance to antihypertensives is evidenced by rising blood pressure levels. The provider may increase
dosage, change medication, or add a diuretic. Joint pain is not associated with this form of tolerance.
6. A client with angina is being treated with a beta-adrenergic blocker. Which assessment findings indicate dose-
related side effects? (Select all that apply.)
1. Dizziness
2. Bradycardia
3. Chest pain
4. Reflex tachycardia
5. Sexual dysfunction
6. Cardiac dysrhythmias
CORRECT ANSWER 1, 2, 5 — Dizziness, Bradycardia, Sexual dysfunction
RATIONALE Beta blocker side effects are usually dose-related and include dizziness (hypotension), bradycardia, and
sexual dysfunction (impotence). Chest pain, reflex tachycardia, and dysrhythmias are reasons for
prescribing beta blockers, not side effects.
, 7. A client with pulmonary congestion from heart failure received IV furosemide 40 mg. After an hour, which finding
indicates the therapy has been effective?
1. The lungs are now clear upon auscultation
2. The urine output has increased by 400 mL
3. The blood pressure has decreased from 118/64 to 106/62
4. The serum potassium has decreased from 4.7 to 4.1 mEq
CORRECT ANSWER 1 — The lungs are now clear upon auscultation
RATIONALE Furosemide was given to decrease preload and reduce pulmonary congestion. Although all options may
occur, clear lung sounds indicate the reason furosemide was administered — resolution of pulmonary
congestion.
8. A client with chronic kidney disease is scheduled for hemodialysis. When should the nurse administer the daily
dose of enalapril?
1. During dialysis
2. Just before dialysis
3. The day after dialysis
4. Upon return from dialysis
CORRECT ANSWER 4 — Upon return from dialysis
RATIONALE Antihypertensives like enalapril are given after hemodialysis to prevent hypotension during dialysis and to
prevent the medication from being removed by dialysis. Waiting a full day would lead to ineffective BP
control.
9. A nurse is caring for a client with a new prescription for captopril for hypertension. Which adverse effect should
the nurse monitor for?
a. Hypokalemia
b. Hypernatremia
c. Neutropenia
d. Bradycardia
CORRECT ANSWER c — Neutropenia
RATIONALE Neutropenia is a serious adverse effect of ACE inhibitors (captopril). Monitor CBC and teach the client to
report signs of infection. Hypokalemia, hypernatremia, and bradycardia are not adverse effects of ACE
inhibitors.
10. A client receiving continuous IV heparin begins to vomit blood. After stopping heparin, which medication should
the nurse administer?
a. Vitamin K
b. Atropine
c. Protamine
d. Calcium gluconate
CORRECT ANSWER c — Protamine
RATIONALE Protamine reverses the anticoagulant effect of heparin. Vitamin K reverses warfarin. Atropine reverses beta-
blocker bradycardia. Calcium gluconate treats magnesium sulfate toxicity.
