4 M A X E • S L AT N E M A D N U F
★ ★
Nursing Fundamentals Assessment
N Comprehensive Examination — Exam 4
EST. 2026
E XC E L L E N C E I N N U RS I N G E D U C AT I O N
Nursing Fundamentals — Exam 4
M E D I C AT I O N A D M I N I S T R AT I O N , PA I N M A N A G E M E N T, PAT I E N T E D U C AT I O N & P E R I O P E R AT I V E C A R E
INSTITUTION Nursing Fundamentals Assessment COURSE CODE Nursing Fundamentals — Exam 4
PROGRAM Practical Nursing (PN) / Associate Degree ACADEMIC YEAR
in Nursing (ADN)
EXAM TITLE Nursing Fundamentals Exam 4 TOTAL QUESTIONS 10 Questions
COURSE TITLE Fundamentals of Nursing FORMAT Multiple Choice / Select All That Apply
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless otherwise instructed.
▸ Select all that apply questions are indicated — choose every correct option.
▸ Questions cover medication administration, pain management, patient education, and perioperative care.
▸ Correct answers and clinical rationales appear below each question for review purposes.
▸ All content reflects current evidence-based nursing practice.
SECTION I — FUNDAMENTALS OF NURSING COMPREHENSIVE Questions 1 –
EXAMINATION 10
1. What is the preferred site for the nurse to perform an IM injection on a patient who is on anticoagulants?
A. Deltoid.
B. Vastus lateralis.
C. Ventrogluteal.
D. Dorsal gluteal.
CORRECT ANSWER C — Ventrogluteal.
RATIONALE The ventrogluteal site is the PREFERRED and safest IM injection site for patients on anticoagulants.
Advantages: (1) Free of major blood vessels and nerves — significantly reduces the risk of bleeding and nerve
injury compared to other sites. (2) The gluteus medius and minimus muscles are well-developed and easily
bypass subcutaneous fat layers. (3) It is the recommended site per evidence-based practice guidelines for all
adults and children over 7 months. The dorsal gluteal site (D) is NO LONGER recommended — it carries risk of
sciatic nerve injury and has unpredictable subcutaneous fat thickness. The deltoid (A) and vastus lateralis (B)
are acceptable IM sites but are not optimal for anticoagulated patients due to smaller muscle mass and higher
risk of hematoma formation. For patients on anticoagulants, IM injections should be avoided when possible;
if required, use the smallest gauge needle, apply prolonged pressure after injection, and monitor for bleeding.
, 2. During medication administration, the nurse realizes she has given the wrong dose. The patient has no visible
alterations. What is the PRIORITY intervention?
A. Document the error.
B. Call the physician.
C. Assess the patient's current status.
D. Ignore the error because nothing happened.
CORRECT ANSWER C — Assess the patient's current status.
RATIONALE The PRIORITY action after a medication error is to ASSESS the patient. The nursing process begins with
assessment — before documenting, before notifying the provider, the nurse must gather data about the
patient's current condition. Even without visible alterations, the patient may have internal effects (e.g.,
hypotension, dysrhythmia, respiratory depression) that require immediate detection. After assessment: (1)
notify the provider (B) with complete assessment data, (2) implement any corrective orders, (3) continue
monitoring, (4) document the error and patient response (A) in the medical record, and (5) complete an
incident report per facility policy (the incident report is NOT mentioned in the medical record). Option D is
NEVER acceptable — ignoring an error violates professional accountability and patient safety. Medication
errors must be reported honestly — a Just Culture promotes reporting without fear of punishment for honest
mistakes to enable system improvement. The nurse demonstrates integrity and accountability by
acknowledging the error and prioritizing patient safety.
3. A patient has a pulse oximetry reading of 82%, an abnormal heart rate, and reports pain in the jaw and lower arm.
The nurse recognizes this as which type of pain related to myocardial infarction?
A. Visceral pain.
B. Referred pain.
C. Non-cancer pain.
D. Somatic pain.
CORRECT ANSWER B — Referred pain.
RATIONALE REFERRED pain is pain perceived at a site different from its origin. In myocardial infarction, cardiac pain is
typically felt in the chest (substernal), but it commonly radiates to the left jaw, left arm, shoulder, neck, or
back. The pain is referred because the heart and these areas share spinal nerve pathways (C3–T4
dermatomes) — the brain misinterprets the source of the pain signal. This is a classic MI presentation. Visceral
pain (A) originates from internal organs — it is often described as deep, aching, cramping, or pressure (the
chest component of MI pain IS visceral, but the jaw/arm radiation makes it referred). Somatic pain (D)
originates from skin, muscles, bones, and joints — it is typically localized and described as sharp or throbbing
(e.g., fracture, incision). Non-cancer pain (C) is acute pain that becomes persistent or chronic but is not
related to malignancy. The nurse must recognize referred pain patterns to accurately assess the underlying
pathology and avoid misdiagnosis.
★ ★
Nursing Fundamentals Assessment
N Comprehensive Examination — Exam 4
EST. 2026
E XC E L L E N C E I N N U RS I N G E D U C AT I O N
Nursing Fundamentals — Exam 4
M E D I C AT I O N A D M I N I S T R AT I O N , PA I N M A N A G E M E N T, PAT I E N T E D U C AT I O N & P E R I O P E R AT I V E C A R E
INSTITUTION Nursing Fundamentals Assessment COURSE CODE Nursing Fundamentals — Exam 4
PROGRAM Practical Nursing (PN) / Associate Degree ACADEMIC YEAR
in Nursing (ADN)
EXAM TITLE Nursing Fundamentals Exam 4 TOTAL QUESTIONS 10 Questions
COURSE TITLE Fundamentals of Nursing FORMAT Multiple Choice / Select All That Apply
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless otherwise instructed.
▸ Select all that apply questions are indicated — choose every correct option.
▸ Questions cover medication administration, pain management, patient education, and perioperative care.
▸ Correct answers and clinical rationales appear below each question for review purposes.
▸ All content reflects current evidence-based nursing practice.
SECTION I — FUNDAMENTALS OF NURSING COMPREHENSIVE Questions 1 –
EXAMINATION 10
1. What is the preferred site for the nurse to perform an IM injection on a patient who is on anticoagulants?
A. Deltoid.
B. Vastus lateralis.
C. Ventrogluteal.
D. Dorsal gluteal.
CORRECT ANSWER C — Ventrogluteal.
RATIONALE The ventrogluteal site is the PREFERRED and safest IM injection site for patients on anticoagulants.
Advantages: (1) Free of major blood vessels and nerves — significantly reduces the risk of bleeding and nerve
injury compared to other sites. (2) The gluteus medius and minimus muscles are well-developed and easily
bypass subcutaneous fat layers. (3) It is the recommended site per evidence-based practice guidelines for all
adults and children over 7 months. The dorsal gluteal site (D) is NO LONGER recommended — it carries risk of
sciatic nerve injury and has unpredictable subcutaneous fat thickness. The deltoid (A) and vastus lateralis (B)
are acceptable IM sites but are not optimal for anticoagulated patients due to smaller muscle mass and higher
risk of hematoma formation. For patients on anticoagulants, IM injections should be avoided when possible;
if required, use the smallest gauge needle, apply prolonged pressure after injection, and monitor for bleeding.
, 2. During medication administration, the nurse realizes she has given the wrong dose. The patient has no visible
alterations. What is the PRIORITY intervention?
A. Document the error.
B. Call the physician.
C. Assess the patient's current status.
D. Ignore the error because nothing happened.
CORRECT ANSWER C — Assess the patient's current status.
RATIONALE The PRIORITY action after a medication error is to ASSESS the patient. The nursing process begins with
assessment — before documenting, before notifying the provider, the nurse must gather data about the
patient's current condition. Even without visible alterations, the patient may have internal effects (e.g.,
hypotension, dysrhythmia, respiratory depression) that require immediate detection. After assessment: (1)
notify the provider (B) with complete assessment data, (2) implement any corrective orders, (3) continue
monitoring, (4) document the error and patient response (A) in the medical record, and (5) complete an
incident report per facility policy (the incident report is NOT mentioned in the medical record). Option D is
NEVER acceptable — ignoring an error violates professional accountability and patient safety. Medication
errors must be reported honestly — a Just Culture promotes reporting without fear of punishment for honest
mistakes to enable system improvement. The nurse demonstrates integrity and accountability by
acknowledging the error and prioritizing patient safety.
3. A patient has a pulse oximetry reading of 82%, an abnormal heart rate, and reports pain in the jaw and lower arm.
The nurse recognizes this as which type of pain related to myocardial infarction?
A. Visceral pain.
B. Referred pain.
C. Non-cancer pain.
D. Somatic pain.
CORRECT ANSWER B — Referred pain.
RATIONALE REFERRED pain is pain perceived at a site different from its origin. In myocardial infarction, cardiac pain is
typically felt in the chest (substernal), but it commonly radiates to the left jaw, left arm, shoulder, neck, or
back. The pain is referred because the heart and these areas share spinal nerve pathways (C3–T4
dermatomes) — the brain misinterprets the source of the pain signal. This is a classic MI presentation. Visceral
pain (A) originates from internal organs — it is often described as deep, aching, cramping, or pressure (the
chest component of MI pain IS visceral, but the jaw/arm radiation makes it referred). Somatic pain (D)
originates from skin, muscles, bones, and joints — it is typically localized and described as sharp or throbbing
(e.g., fracture, incision). Non-cancer pain (C) is acute pain that becomes persistent or chronic but is not
related to malignancy. The nurse must recognize referred pain patterns to accurately assess the underlying
pathology and avoid misdiagnosis.
