2 M A X E • S L AT N E M A D N U F
★ ★
Nursing Fundamentals Assessment
N Comprehensive Examination — Exam 2
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
Fundamentals of Nursing — Exam 2
O L D E R A D U LTS , CO M M U N I C AT I O N , PAT I E N T E D U C AT I O N , M O B I L I T Y & D O C U M E N TAT I O N
INSTITUTION Nursing Fundamentals Assessment COURSE CODE Fundamentals of Nursing — Exam 2
PROGRAM Practical Nursing (PN) / Associate Degree ACADEMIC YEAR
in Nursing (ADN)
EXAM TITLE Fundamentals of Nursing Exam 2 TOTAL QUESTIONS 50 Questions
COURSE TITLE Fundamentals of Nursing FORMAT Multiple Choice — Select the Single Best
Answer
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 older adult care, communication, patient education, mobility, and documentation.
▸ Correct answers and clinical rationales appear below each question for review purposes.
▸ All content reflects current evidence-based nursing practice and ANA standards.
SECTION I — FUNDAMENTALS OF NURSING COMPREHENSIVE Questions 1 –
EXAMINATION 50
1. The nurse is assessing an older adult for cognitive changes. Which finding would the nurse consider a normal age-
related change?
A. Disorientation to time and place.
B. Getting lost in familiar places.
C. Slower recall and reaction time.
D. Loss of language skills.
CORRECT ANSWER C — Slower recall and reaction time.
RATIONALE Normal cognitive aging includes slower recall of information (takes longer to retrieve memories), occasionally
misplacing things, and forgetfulness that does not interfere with daily function. These changes are benign
and do not indicate pathology. Abnormal findings that are NOT part of normal aging include: disorientation,
loss of language skills, getting lost in familiar places, trouble following directions, loss of calculation ability,
and poor judgment — these suggest delirium, dementia, or depression requiring further evaluation.
,2. The nurse is using the SPICES acronym to assess an older adult. What does SPICES stand for?
A. Safety, Pain, Infection, Circulation, Exercise, Skin.
B. Sleep disorders, Problems with eating/feeding, Incontinence, Confusion, Evidence of falls, Skin breakdown.
C. Sensory, Psychological, Integumentary, Cardiovascular, Endocrine, Skeletal.
D. Social, Physical, Intellectual, Cultural, Emotional, Spiritual.
CORRECT ANSWER B — Sleep disorders, Problems with eating/feeding, Incontinence, Confusion, Evidence of falls, Skin
breakdown.
RATIONALE SPICES is an evidence-based assessment tool for identifying common geriatric syndromes: S = Sleep
disorders, P = Problems with eating or feeding, I = Incontinence, C = Confusion, E = Evidence of falls, S = Skin
breakdown. These six areas represent the most common and impactful health problems in older adults.
Regular SPICES assessment helps the nurse detect problems early and implement preventive interventions.
The 4M's framework (What Matters, Medications, Mentation, Mobility) is another geriatric assessment
approach.
3. An older adult patient with no acute distress reports being less able to taste and smell. What is the nurse's best
response?
A. "You should see a neurologist immediately."
B. "These changes are not normal and require further testing."
C. "Diminished senses of taste and smell are normal age-related changes."
D. "You probably have an infection causing this."
CORRECT ANSWER C — "Diminished senses of taste and smell are normal age-related changes."
RATIONALE Diminished taste (often due to fewer taste buds) and diminished sense of smell are normal physiological
changes of aging. The nurse should educate the patient that these are expected and not necessarily
pathological. However, decreased taste and smell can affect appetite and nutrition, so the nurse should also
discuss strategies to enhance food appeal (seasonings, colorful presentation, texture variety). Neurologist
referral, extensive testing, or assuming infection are not indicated for a normal age-related sensory change in
the absence of other concerning symptoms.
4. Which of the following is the biggest sign of elder abuse?
A. Unexplained bruises on the arms.
B. Poor personal hygiene.
C. A caregiver who refuses to leave the room.
D. Weight loss.
CORRECT ANSWER C — A caregiver who refuses to leave the room.
RATIONALE A caregiver who refuses to leave the patient alone with healthcare providers is the most significant red flag for
elder abuse. This behavior prevents the patient from speaking privately and disclosing abuse. The nurse must
find a way to interview the patient alone — this is a mandatory screening requirement. Unexplained bruises,
poor hygiene, and weight loss may be signs of abuse or neglect but can also have other causes. The
caregiver's controlling behavior is a direct behavioral indicator that must trigger immediate further
assessment per mandatory reporting laws.
, 5. A patient is experiencing altered presentation of a urinary tract infection (UTI). Which symptoms would the nurse
expect in an older adult?
A. Dysuria, urinary frequency, and flank pain.
B. Incontinence, falls, and slight fever.
C. Chest pain and shortness of breath.
D. Nausea, vomiting, and diarrhea.
CORRECT ANSWER B — Incontinence, falls, and slight fever.
RATIONALE Older adults often present atypically with infections. Instead of the classic UTI symptoms (dysuria, frequency,
urgency), they may present with new or worsening incontinence, falls, confusion/acute mental status change,
slight fever (or even normothermia — older adults may not mount a robust fever response due to decreased
immune function and lower core temperature), decreased appetite, and generalized functional decline. The
nurse must consider UTI when an older adult presents with nonspecific deterioration. Altered presentation
also occurs with pneumonia (confusion, tachypnea) and MI (dyspnea, anxiety, confusion).
6. Which of the following physiological changes is expected in the older adult's genitourinary system?
A. Increased renal blood flow.
B. Enlarged bladder capacity.
C. Decreased number of nephrons and reduced bladder capacity.
D. Improved sphincter tone.
CORRECT ANSWER C — Decreased number of nephrons and reduced bladder capacity.
RATIONALE Genitourinary aging changes include: fewer functioning nephrons (reduced renal reserve), approximately
50% decrease in renal blood flow by age 80, decreased bladder capacity, and reduced ability to concentrate
urine. Males experience prostate enlargement (BPH) causing urinary hesitancy, frequency, and nocturia.
Females experience reduced sphincter tone (stress incontinence). These changes increase vulnerability to
dehydration, electrolyte imbalances, drug toxicity (decreased renal clearance), and UTIs. Renal function
should be assessed by GFR, not just serum creatinine.
7. A patient has been on bed rest for over 5 days. Which assessment finding may indicate a complication of
immobility?
A. Increased appetite.
B. Decreased peristalsis.
C. Improved muscle strength.
D. Increased respiratory depth.
CORRECT ANSWER B — Decreased peristalsis.
RATIONALE Immobility slows all body systems, including the gastrointestinal system — decreased peristalsis leads to
constipation, gas accumulation, abdominal distention, and potential fecal impaction or paralytic ileus. Other
immobility complications include: muscle atrophy and weakness (not improved), decreased respiratory
depth (shallow breathing leads to atelectasis and pneumonia), orthostatic hypotension, DVT, pressure ulcers,
urinary stasis/UTIs, renal calculi, contractures, and psychological effects (depression, social isolation). Early
ambulation and repositioning prevent these complications.
★ ★
Nursing Fundamentals Assessment
N Comprehensive Examination — Exam 2
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
Fundamentals of Nursing — Exam 2
O L D E R A D U LTS , CO M M U N I C AT I O N , PAT I E N T E D U C AT I O N , M O B I L I T Y & D O C U M E N TAT I O N
INSTITUTION Nursing Fundamentals Assessment COURSE CODE Fundamentals of Nursing — Exam 2
PROGRAM Practical Nursing (PN) / Associate Degree ACADEMIC YEAR
in Nursing (ADN)
EXAM TITLE Fundamentals of Nursing Exam 2 TOTAL QUESTIONS 50 Questions
COURSE TITLE Fundamentals of Nursing FORMAT Multiple Choice — Select the Single Best
Answer
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 older adult care, communication, patient education, mobility, and documentation.
▸ Correct answers and clinical rationales appear below each question for review purposes.
▸ All content reflects current evidence-based nursing practice and ANA standards.
SECTION I — FUNDAMENTALS OF NURSING COMPREHENSIVE Questions 1 –
EXAMINATION 50
1. The nurse is assessing an older adult for cognitive changes. Which finding would the nurse consider a normal age-
related change?
A. Disorientation to time and place.
B. Getting lost in familiar places.
C. Slower recall and reaction time.
D. Loss of language skills.
CORRECT ANSWER C — Slower recall and reaction time.
RATIONALE Normal cognitive aging includes slower recall of information (takes longer to retrieve memories), occasionally
misplacing things, and forgetfulness that does not interfere with daily function. These changes are benign
and do not indicate pathology. Abnormal findings that are NOT part of normal aging include: disorientation,
loss of language skills, getting lost in familiar places, trouble following directions, loss of calculation ability,
and poor judgment — these suggest delirium, dementia, or depression requiring further evaluation.
,2. The nurse is using the SPICES acronym to assess an older adult. What does SPICES stand for?
A. Safety, Pain, Infection, Circulation, Exercise, Skin.
B. Sleep disorders, Problems with eating/feeding, Incontinence, Confusion, Evidence of falls, Skin breakdown.
C. Sensory, Psychological, Integumentary, Cardiovascular, Endocrine, Skeletal.
D. Social, Physical, Intellectual, Cultural, Emotional, Spiritual.
CORRECT ANSWER B — Sleep disorders, Problems with eating/feeding, Incontinence, Confusion, Evidence of falls, Skin
breakdown.
RATIONALE SPICES is an evidence-based assessment tool for identifying common geriatric syndromes: S = Sleep
disorders, P = Problems with eating or feeding, I = Incontinence, C = Confusion, E = Evidence of falls, S = Skin
breakdown. These six areas represent the most common and impactful health problems in older adults.
Regular SPICES assessment helps the nurse detect problems early and implement preventive interventions.
The 4M's framework (What Matters, Medications, Mentation, Mobility) is another geriatric assessment
approach.
3. An older adult patient with no acute distress reports being less able to taste and smell. What is the nurse's best
response?
A. "You should see a neurologist immediately."
B. "These changes are not normal and require further testing."
C. "Diminished senses of taste and smell are normal age-related changes."
D. "You probably have an infection causing this."
CORRECT ANSWER C — "Diminished senses of taste and smell are normal age-related changes."
RATIONALE Diminished taste (often due to fewer taste buds) and diminished sense of smell are normal physiological
changes of aging. The nurse should educate the patient that these are expected and not necessarily
pathological. However, decreased taste and smell can affect appetite and nutrition, so the nurse should also
discuss strategies to enhance food appeal (seasonings, colorful presentation, texture variety). Neurologist
referral, extensive testing, or assuming infection are not indicated for a normal age-related sensory change in
the absence of other concerning symptoms.
4. Which of the following is the biggest sign of elder abuse?
A. Unexplained bruises on the arms.
B. Poor personal hygiene.
C. A caregiver who refuses to leave the room.
D. Weight loss.
CORRECT ANSWER C — A caregiver who refuses to leave the room.
RATIONALE A caregiver who refuses to leave the patient alone with healthcare providers is the most significant red flag for
elder abuse. This behavior prevents the patient from speaking privately and disclosing abuse. The nurse must
find a way to interview the patient alone — this is a mandatory screening requirement. Unexplained bruises,
poor hygiene, and weight loss may be signs of abuse or neglect but can also have other causes. The
caregiver's controlling behavior is a direct behavioral indicator that must trigger immediate further
assessment per mandatory reporting laws.
, 5. A patient is experiencing altered presentation of a urinary tract infection (UTI). Which symptoms would the nurse
expect in an older adult?
A. Dysuria, urinary frequency, and flank pain.
B. Incontinence, falls, and slight fever.
C. Chest pain and shortness of breath.
D. Nausea, vomiting, and diarrhea.
CORRECT ANSWER B — Incontinence, falls, and slight fever.
RATIONALE Older adults often present atypically with infections. Instead of the classic UTI symptoms (dysuria, frequency,
urgency), they may present with new or worsening incontinence, falls, confusion/acute mental status change,
slight fever (or even normothermia — older adults may not mount a robust fever response due to decreased
immune function and lower core temperature), decreased appetite, and generalized functional decline. The
nurse must consider UTI when an older adult presents with nonspecific deterioration. Altered presentation
also occurs with pneumonia (confusion, tachypnea) and MI (dyspnea, anxiety, confusion).
6. Which of the following physiological changes is expected in the older adult's genitourinary system?
A. Increased renal blood flow.
B. Enlarged bladder capacity.
C. Decreased number of nephrons and reduced bladder capacity.
D. Improved sphincter tone.
CORRECT ANSWER C — Decreased number of nephrons and reduced bladder capacity.
RATIONALE Genitourinary aging changes include: fewer functioning nephrons (reduced renal reserve), approximately
50% decrease in renal blood flow by age 80, decreased bladder capacity, and reduced ability to concentrate
urine. Males experience prostate enlargement (BPH) causing urinary hesitancy, frequency, and nocturia.
Females experience reduced sphincter tone (stress incontinence). These changes increase vulnerability to
dehydration, electrolyte imbalances, drug toxicity (decreased renal clearance), and UTIs. Renal function
should be assessed by GFR, not just serum creatinine.
7. A patient has been on bed rest for over 5 days. Which assessment finding may indicate a complication of
immobility?
A. Increased appetite.
B. Decreased peristalsis.
C. Improved muscle strength.
D. Increased respiratory depth.
CORRECT ANSWER B — Decreased peristalsis.
RATIONALE Immobility slows all body systems, including the gastrointestinal system — decreased peristalsis leads to
constipation, gas accumulation, abdominal distention, and potential fecal impaction or paralytic ileus. Other
immobility complications include: muscle atrophy and weakness (not improved), decreased respiratory
depth (shallow breathing leads to atelectasis and pneumonia), orthostatic hypotension, DVT, pressure ulcers,
urinary stasis/UTIs, renal calculi, contractures, and psychological effects (depression, social isolation). Early
ambulation and repositioning prevent these complications.
