College of Nursing
4 MAXE SDNUF
★ ★
N Department of Health Sciences
SCIENTIA · CURA · COMPASSIO
EST. 1908
Nursing Fundamentals — Examination 4
M O B I L I TY · N U T R I T I O N · E L I M I N AT I O N · F LU I D / E L E C T R O LYT E S · I V T H E R A P Y · A C I D - B A S E
INSTITUTION College of Nursing COURSE CODE NURS 1101
PROGRAM Bachelor of Science in Nursing (BSN) ACADEMIC YEAR
EXAM TITLE Nursing Fundamentals Exam 4 TOTAL QUESTIONS 80+ Questions
COURSE TITLE Nursing Fundamentals FORMAT Multiple Choice & Select All That Apply
EXAMINATION INSTRUCTIONS
▸ This comprehensive exam covers mobility/immobility, nutrition, urinary/bowel elimination, fluid/electrolytes, IV therapy, and
acid-base balance.
▸ 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 — MOBILITY, IMMOBILITY & EXERCISE Questions 1 – 22
1. An older-adult patient has been bedridden for 2 weeks. Which complaint indicates a complication of immobility?
A. Loss of appetite
B. Gum soreness
C. Difficulty swallowing
D. Left-ankle joint stiffness
CORRECT ANSWER D — Left-ankle joint stiffness
RATIONALE Joint stiffness (contractures) is a classic complication of immobility. Prolonged bed rest leads to decreased
joint mobility, muscle atrophy, and contracture formation. Loss of appetite, gum soreness, and difficulty
swallowing are not direct complications of immobility.
2. An older adult post-total knee replacement has difficulty breathing while lying flat. Which assessment data
support a pulmonary problem related to impaired mobility? (Select all that apply.)
1. B/P = 128/84
2. Respirations 26/min on room air
3. HR 114
4. Crackles over lower lobes heard on auscultation
5. Pain reported as 3 on scale of 0 to 10 after medication
CORRECT ANSWER 2, 3, 4 — Tachypnea, tachycardia, crackles
RATIONALE Pulmonary complications of immobility include atelectasis and pneumonia. Signs include increased
respiratory rate (26), tachycardia (114), and adventitious lung sounds (crackles). Normal BP and controlled
pain are not indicators of pulmonary problems.
,3. Which menu should the nurse recommend for a patient who needs increased calcium intake for osteoporosis
prevention?
A. Cream of broccoli soup with whole wheat crackers, cheese, and tapioca for dessert
B. Hot dog on whole wheat bun with a side salad and an apple for dessert
C. Low-fat turkey chili with sour cream with a side salad and fresh pears for dessert
D. Turkey salad on toast with tomato and lettuce and honey bun for dessert
CORRECT ANSWER A — Cream of broccoli soup, cheese, tapioca
RATIONALE This menu is highest in calcium: broccoli, cheese, and tapioca (made with milk) are all calcium-rich. The
other options lack significant calcium sources. Calcium is essential for bone health and osteoporosis
prevention.
4. What is the correct order for applying elastic stockings?
CORRECT ANSWER 1. Identify patient (2 identifiers) → 5. Assess skin/circulation → 7. Measure legs → 4. Turn stocking
inside out to heel → 6. Place toes in → 3. Slide over heel and up leg → 2. Smooth creases
RATIONALE Proper application sequence: verify patient, assess baseline, measure for correct size, turn inside out, apply
from toes upward, then smooth wrinkles. Wrinkled stockings create a tourniquet effect and increase DVT
risk.
5. A patient receives heparin 5000 units subcutaneously q12h on bed rest. Which signs of bleeding should the nurse
assess? (Select all that apply.)
1. Bruising
2. Pale yellow urine
3. Bleeding gums
4. Coffee ground-like vomitus
5. Light brown stool
CORRECT ANSWER 1, 3, 4 — Bruising, bleeding gums, coffee-ground emesis
RATIONALE Heparin is an anticoagulant. Signs of bleeding include ecchymoses (bruising), gingival bleeding, and
hematemesis (coffee-ground vomitus indicates GI bleeding). Dark/tarry stools (not light brown) indicate GI
bleeding. Pale yellow urine is normal.
6. What is the most effective activity on the first postoperative day after abdominal surgery to prevent complications
of immobility?
A. Turn, cough, and deep breathe every 30 minutes while awake
B. Ambulate patient to chair in the hall
C. Passive range of motion 4 times a day
D. Immobility is not a concern the first postoperative day
CORRECT ANSWER B — Ambulate patient to chair in the hall
RATIONALE Early ambulation is the most effective intervention to prevent immobility complications (atelectasis, DVT,
constipation, pressure ulcers). Getting the patient out of bed on the first postoperative day is the gold
standard for prevention.
, 7. A patient on prolonged bed rest is at increased risk for which common complication of immobility?
A. Myoclonus
B. Pathological fractures
C. Pressure ulcers
D. Pruritus
CORRECT ANSWER C — Pressure ulcers
RATIONALE Prolonged pressure on bony prominences from immobility leads to tissue ischemia and pressure ulcer
formation. Myoclonus (muscle jerking), pathological fractures, and pruritus (itching) are not common direct
complications of bed rest.
8. Which intervention maintains a patent airway in a patient on bed rest?
A. Isometric exercises
B. Administration of low-dose heparin
C. Suctioning every 4 hours
D. Use of incentive spirometer every 2 hours while awake
CORRECT ANSWER D — Incentive spirometer every 2 hours while awake
RATIONALE Incentive spirometry promotes deep breathing, prevents atelectasis, and maintains airway patency.
Isometric exercises prevent muscle atrophy. Heparin prevents DVT. Routine suctioning is not indicated
without secretions.
9. The nurse evaluates that the NAP applied a sequential compression device (SCD) appropriately when which is
observed? (Select all that apply.)
1. Initial measurement is made around the calves
2. Inflation pressure averages 40 mm Hg
3. Patient's leg placed with back of knee aligned with popliteal opening
4. Stockings removed every 2 hours during application
5. Yellow light indicates SCD device is functioning
CORRECT ANSWER 2, 3 — Inflation pressure 40 mm Hg; popliteal opening aligned
RATIONALE SCDs should inflate to approximately 40 mm Hg. The popliteal opening should align with the back of the
knee. Measurements are made around the thighs, not calves. SCDs are worn continuously except for skin
assessment. A green light (not yellow) indicates proper function.
10. A patient has been on bed rest for over 4 days. Which sign is associated with immobility?
A. Decreased peristalsis
B. Decreased heart rate
C. Increased blood pressure
D. Increased urinary output
CORRECT ANSWER A — Decreased peristalsis
RATIONALE Immobility slows GI motility (decreased peristalsis), leading to constipation. Immobility typically causes
increased heart rate (not decreased), orthostatic hypotension (not increased BP), and decreased urinary
output related to stasis.
4 MAXE SDNUF
★ ★
N Department of Health Sciences
SCIENTIA · CURA · COMPASSIO
EST. 1908
Nursing Fundamentals — Examination 4
M O B I L I TY · N U T R I T I O N · E L I M I N AT I O N · F LU I D / E L E C T R O LYT E S · I V T H E R A P Y · A C I D - B A S E
INSTITUTION College of Nursing COURSE CODE NURS 1101
PROGRAM Bachelor of Science in Nursing (BSN) ACADEMIC YEAR
EXAM TITLE Nursing Fundamentals Exam 4 TOTAL QUESTIONS 80+ Questions
COURSE TITLE Nursing Fundamentals FORMAT Multiple Choice & Select All That Apply
EXAMINATION INSTRUCTIONS
▸ This comprehensive exam covers mobility/immobility, nutrition, urinary/bowel elimination, fluid/electrolytes, IV therapy, and
acid-base balance.
▸ 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 — MOBILITY, IMMOBILITY & EXERCISE Questions 1 – 22
1. An older-adult patient has been bedridden for 2 weeks. Which complaint indicates a complication of immobility?
A. Loss of appetite
B. Gum soreness
C. Difficulty swallowing
D. Left-ankle joint stiffness
CORRECT ANSWER D — Left-ankle joint stiffness
RATIONALE Joint stiffness (contractures) is a classic complication of immobility. Prolonged bed rest leads to decreased
joint mobility, muscle atrophy, and contracture formation. Loss of appetite, gum soreness, and difficulty
swallowing are not direct complications of immobility.
2. An older adult post-total knee replacement has difficulty breathing while lying flat. Which assessment data
support a pulmonary problem related to impaired mobility? (Select all that apply.)
1. B/P = 128/84
2. Respirations 26/min on room air
3. HR 114
4. Crackles over lower lobes heard on auscultation
5. Pain reported as 3 on scale of 0 to 10 after medication
CORRECT ANSWER 2, 3, 4 — Tachypnea, tachycardia, crackles
RATIONALE Pulmonary complications of immobility include atelectasis and pneumonia. Signs include increased
respiratory rate (26), tachycardia (114), and adventitious lung sounds (crackles). Normal BP and controlled
pain are not indicators of pulmonary problems.
,3. Which menu should the nurse recommend for a patient who needs increased calcium intake for osteoporosis
prevention?
A. Cream of broccoli soup with whole wheat crackers, cheese, and tapioca for dessert
B. Hot dog on whole wheat bun with a side salad and an apple for dessert
C. Low-fat turkey chili with sour cream with a side salad and fresh pears for dessert
D. Turkey salad on toast with tomato and lettuce and honey bun for dessert
CORRECT ANSWER A — Cream of broccoli soup, cheese, tapioca
RATIONALE This menu is highest in calcium: broccoli, cheese, and tapioca (made with milk) are all calcium-rich. The
other options lack significant calcium sources. Calcium is essential for bone health and osteoporosis
prevention.
4. What is the correct order for applying elastic stockings?
CORRECT ANSWER 1. Identify patient (2 identifiers) → 5. Assess skin/circulation → 7. Measure legs → 4. Turn stocking
inside out to heel → 6. Place toes in → 3. Slide over heel and up leg → 2. Smooth creases
RATIONALE Proper application sequence: verify patient, assess baseline, measure for correct size, turn inside out, apply
from toes upward, then smooth wrinkles. Wrinkled stockings create a tourniquet effect and increase DVT
risk.
5. A patient receives heparin 5000 units subcutaneously q12h on bed rest. Which signs of bleeding should the nurse
assess? (Select all that apply.)
1. Bruising
2. Pale yellow urine
3. Bleeding gums
4. Coffee ground-like vomitus
5. Light brown stool
CORRECT ANSWER 1, 3, 4 — Bruising, bleeding gums, coffee-ground emesis
RATIONALE Heparin is an anticoagulant. Signs of bleeding include ecchymoses (bruising), gingival bleeding, and
hematemesis (coffee-ground vomitus indicates GI bleeding). Dark/tarry stools (not light brown) indicate GI
bleeding. Pale yellow urine is normal.
6. What is the most effective activity on the first postoperative day after abdominal surgery to prevent complications
of immobility?
A. Turn, cough, and deep breathe every 30 minutes while awake
B. Ambulate patient to chair in the hall
C. Passive range of motion 4 times a day
D. Immobility is not a concern the first postoperative day
CORRECT ANSWER B — Ambulate patient to chair in the hall
RATIONALE Early ambulation is the most effective intervention to prevent immobility complications (atelectasis, DVT,
constipation, pressure ulcers). Getting the patient out of bed on the first postoperative day is the gold
standard for prevention.
, 7. A patient on prolonged bed rest is at increased risk for which common complication of immobility?
A. Myoclonus
B. Pathological fractures
C. Pressure ulcers
D. Pruritus
CORRECT ANSWER C — Pressure ulcers
RATIONALE Prolonged pressure on bony prominences from immobility leads to tissue ischemia and pressure ulcer
formation. Myoclonus (muscle jerking), pathological fractures, and pruritus (itching) are not common direct
complications of bed rest.
8. Which intervention maintains a patent airway in a patient on bed rest?
A. Isometric exercises
B. Administration of low-dose heparin
C. Suctioning every 4 hours
D. Use of incentive spirometer every 2 hours while awake
CORRECT ANSWER D — Incentive spirometer every 2 hours while awake
RATIONALE Incentive spirometry promotes deep breathing, prevents atelectasis, and maintains airway patency.
Isometric exercises prevent muscle atrophy. Heparin prevents DVT. Routine suctioning is not indicated
without secretions.
9. The nurse evaluates that the NAP applied a sequential compression device (SCD) appropriately when which is
observed? (Select all that apply.)
1. Initial measurement is made around the calves
2. Inflation pressure averages 40 mm Hg
3. Patient's leg placed with back of knee aligned with popliteal opening
4. Stockings removed every 2 hours during application
5. Yellow light indicates SCD device is functioning
CORRECT ANSWER 2, 3 — Inflation pressure 40 mm Hg; popliteal opening aligned
RATIONALE SCDs should inflate to approximately 40 mm Hg. The popliteal opening should align with the back of the
knee. Measurements are made around the thighs, not calves. SCDs are worn continuously except for skin
assessment. A green light (not yellow) indicates proper function.
10. A patient has been on bed rest for over 4 days. Which sign is associated with immobility?
A. Decreased peristalsis
B. Decreased heart rate
C. Increased blood pressure
D. Increased urinary output
CORRECT ANSWER A — Decreased peristalsis
RATIONALE Immobility slows GI motility (decreased peristalsis), leading to constipation. Immobility typically causes
increased heart rate (not decreased), orthostatic hypotension (not increased BP), and decreased urinary
output related to stasis.
