NUR 104 FINAL EXAM 1
EXCELSIOR UNIVERSITY
ACTUAL EXAM PAPER 2026/2027
100 Questions | 100% Verified
Foundations of Nursing
Verified | 2026/2027 Excelsior University Nursing Curriculum & NGN Standards
Next Generation NCLEX (NGN) | NCSBN Clinical Judgment Measurement Model
,Key Features
✓ Excelsior University NUR 104 foundational nursing concepts and the nursing process (ADPIE)
✓ Comprehensive health assessment and physical examination techniques
✓ Basic pharmacology and safe medication administration principles
✓ Infection control, safety, and evidence-based patient care
✓ Professional communication, ethics, and legal responsibilities in nursing
Updates for 2026
1. Full integration of the NCSBN Clinical Judgment Measurement Model (CJMM) in
Excelsior case scenarios — The 2026 Excelsior University NUR 104 curriculum fully
integrates the NCSBN Clinical Judgment Measurement Model across all foundational case
scenarios, requiring nursing students to systematically recognize cues, analyze findings, prioritize
hypotheses, generate solutions, take action, and evaluate outcomes in every clinical situation,
thereby aligning foundational education with the Next Generation NCLEX competency
framework.
2. Updated 2026 National Patient Safety Goals (NPSGs) for identifying patient
errors and fall prevention — The Joint Commission has updated its 2026 National Patient
Safety Goals with enhanced protocols for patient identification using two identifiers, medication
safety with look-alike and sound-alike drug differentiation, and revised fall prevention standards
incorporating the Morse Fall Scale, requiring nursing students to demonstrate competency in
applying these goals during fundamental clinical rotations.
3. New frameworks for addressing social determinants of health (SDOH) and health
equity during the initial nursing assessment — The 2026 foundational curriculum
introduces structured frameworks for screening and documenting social determinants of health,
including housing stability, food security, transportation access, and health literacy, requiring
nursing students to incorporate SDOH assessment into the comprehensive admission nursing
assessment to promote health equity and patient-centered care planning.
Abstract
This document presents a comprehensive 100-question actual final examination designed to
assess the foundational nursing competencies required for NUR 104 Final Exam 1 at Excelsior
University, as defined by the 2026/2027 foundational nursing curriculum and aligned with Next
Generation NCLEX (NGN) standards. The questions are systematically distributed across five
core content domains: Nursing Process and Clinical Judgment (20%), Health Assessment and
Vital Signs (25%), Safety Infection Control and Ethics (25%), Basic Pharmacology and Medication
Safety (15%), and Professional Communication and Documentation (15%). Each question is
accompanied by a detailed rationale grounded in current evidence-based standards for
foundational nursing practice, a systematic explanation of why each distractor is incorrect, and a
specific reference to the 2026 NUR 104 Excelsior University course module, foundational nursing
textbook chapter (Potter and Perry, Jarvis), or current clinical guideline from which the question
is derived. The examination emphasizes the practical application of the nursing process (ADPIE),
the NCSBN Clinical Judgment Measurement Model (CJMM), and the integration of theoretical
knowledge, clinical reasoning, and basic psychomotor skills required for safe, patient-centered
care across diverse clinical settings and patient populations.
Keywords
NUR 104, Excelsior University, Foundations of Nursing, Final Exam, Nursing Process, ADPIE,
Health Assessment, Infection Control, Patient Safety, Clinical Judgment, NGN
,Content Area Overview
Content Area Questions Key Topics Weight
Nursing Process & 1-20 ADPIE, CJMM, 20%
Clinical Judgment NANDA-I, SMART
goals, prioritization,
EBP
Health Assessment & 21-45 Vital signs, exam 25%
Vital Signs techniques, APGAR,
GCS, pain scales
Safety, Infection 46-70 Chain of infection, 25%
Control & Ethics PPE, isolation, ethics,
HIPAA, restraints
Basic Pharmacology 71-85 10 Rights, dosage 15%
& Medication Safety calc, controlled
substances,
pharmacokinetics
Professional 86-100 Therapeutic 15%
Communication & communication,
Documentation SBAR, EHR, cultural
competence
Examination Questions
Domain: Nursing Process & Clinical Judgment
Q1. A nurse is caring for a newly admitted patient with heart failure. Which action
represents the first step of the nursing process (ADPIE)?
A. Establishing goals for fluid balance
B. Collecting a comprehensive health history
C. Administering prescribed furosemide
D. Determining that fluid volume excess exists
Correct Answer: B. Collecting a comprehensive health history
Rationale: Assessment is the first step of the nursing process and involves systematically
collecting subjective and objective data to build a comprehensive patient database. Before
diagnosing, planning, or implementing, the nurse must gather information such as health
history, physical examination findings, and laboratory values. This database forms the
foundation for all subsequent clinical decisions and care planning.
Why Wrong: Establishing goals is the planning step, which occurs after assessment and diagnosis
are complete. Administering medications is implementation, which follows the planning step.
Determining fluid volume excess is diagnosis, which follows the assessment step.
Reference: Potter & Perry Fundamentals of Nursing, Chapter 3
Q2. According to the NCSBN Clinical Judgment Measurement Model (CJMM), a
nurse observes that a postoperative patient's respiratory rate increased from 16 to
28 breaths/min. Which CJMM step does this observation represent?
A. Recognize cues
B. Analyze cues
C. Take action
D. Evaluate outcomes
Correct Answer: A. Recognize cues
Rationale: Recognizing cues is the first layer of the NCSBN CJMM and involves identifying
relevant clinical information such as changes in vital signs from the patient's environment. The
, increased respiratory rate is a cue that warrants the nurse's attention before any further
interpretation. After recognizing the cue, the nurse would proceed to analyze its meaning and
clinical significance.
Why Wrong: Analyze cues involves comparing findings to expected ranges, which follows
recognition of the cue. Take action involves implementing interventions after solutions are
generated later in the model. Evaluate outcomes is the final step, assessing whether actions were
effective.
Reference: NCSBN CJMM Framework 2026
Q3. A nurse caring for a patient with a sodium level of 128 mEq/L notes new-onset
confusion and muscle weakness. In the NCSBN CJMM, comparing these findings to
expected values represents which step?
A. Recognize cues
B. Analyze cues
C. Prioritize hypotheses
D. Generate solutions
Correct Answer: B. Analyze cues
Rationale: Analyzing cues involves interpreting collected data by comparing findings to
expected values and the patient's baseline. The nurse links the hyponatremia to the symptoms of
confusion and weakness to determine clinical significance. This step bridges raw data
recognition and the prioritization of hypotheses.
Why Wrong: Recognize cues is identifying the data, which precedes the analysis step. Prioritize
hypotheses involves ranking possible explanations, which follows analysis of cues. Generate
solutions involves planning interventions, which comes later in the model.
Reference: NCSBN CJMM Framework 2026
Q4. A patient presents with acute dyspnea, wheezing, and an oxygen saturation of
88%. Using the NCSBN CJMM, ranking impaired gas exchange as the highest-
priority problem represents which step?
A. Recognize cues
B. Analyze cues
C. Prioritize hypotheses
D. Evaluate outcomes
Correct Answer: C. Prioritize hypotheses
Rationale: Prioritizing hypotheses involves ranking potential explanations or problems by
urgency and clinical significance. The nurse determines that impaired gas exchange is the most
immediate threat to the patient's life and addresses it first. This step guides which problem the
nurse takes action on before others.
Why Wrong: Recognize cues is identifying data, which occurs earlier in the model. Analyze cues is
interpreting data, which precedes the prioritization of hypotheses. Evaluate outcomes is assessing
results after intervention, the last step of the model.
Reference: NCSBN CJMM Framework 2026
Q5. A nurse identifies a patient at risk for falls. In the NCSBN CJMM, which step
includes identifying interventions such as bed alarms and hourly rounding?
A. Generate solutions
B. Take action
C. Recognize cues
D. Evaluate outcomes
Correct Answer: A. Generate solutions
Rationale: Generating solutions involves identifying appropriate interventions and a plan of
care to address the prioritized hypotheses. For fall risk, solutions include bed alarms, hourly
EXCELSIOR UNIVERSITY
ACTUAL EXAM PAPER 2026/2027
100 Questions | 100% Verified
Foundations of Nursing
Verified | 2026/2027 Excelsior University Nursing Curriculum & NGN Standards
Next Generation NCLEX (NGN) | NCSBN Clinical Judgment Measurement Model
,Key Features
✓ Excelsior University NUR 104 foundational nursing concepts and the nursing process (ADPIE)
✓ Comprehensive health assessment and physical examination techniques
✓ Basic pharmacology and safe medication administration principles
✓ Infection control, safety, and evidence-based patient care
✓ Professional communication, ethics, and legal responsibilities in nursing
Updates for 2026
1. Full integration of the NCSBN Clinical Judgment Measurement Model (CJMM) in
Excelsior case scenarios — The 2026 Excelsior University NUR 104 curriculum fully
integrates the NCSBN Clinical Judgment Measurement Model across all foundational case
scenarios, requiring nursing students to systematically recognize cues, analyze findings, prioritize
hypotheses, generate solutions, take action, and evaluate outcomes in every clinical situation,
thereby aligning foundational education with the Next Generation NCLEX competency
framework.
2. Updated 2026 National Patient Safety Goals (NPSGs) for identifying patient
errors and fall prevention — The Joint Commission has updated its 2026 National Patient
Safety Goals with enhanced protocols for patient identification using two identifiers, medication
safety with look-alike and sound-alike drug differentiation, and revised fall prevention standards
incorporating the Morse Fall Scale, requiring nursing students to demonstrate competency in
applying these goals during fundamental clinical rotations.
3. New frameworks for addressing social determinants of health (SDOH) and health
equity during the initial nursing assessment — The 2026 foundational curriculum
introduces structured frameworks for screening and documenting social determinants of health,
including housing stability, food security, transportation access, and health literacy, requiring
nursing students to incorporate SDOH assessment into the comprehensive admission nursing
assessment to promote health equity and patient-centered care planning.
Abstract
This document presents a comprehensive 100-question actual final examination designed to
assess the foundational nursing competencies required for NUR 104 Final Exam 1 at Excelsior
University, as defined by the 2026/2027 foundational nursing curriculum and aligned with Next
Generation NCLEX (NGN) standards. The questions are systematically distributed across five
core content domains: Nursing Process and Clinical Judgment (20%), Health Assessment and
Vital Signs (25%), Safety Infection Control and Ethics (25%), Basic Pharmacology and Medication
Safety (15%), and Professional Communication and Documentation (15%). Each question is
accompanied by a detailed rationale grounded in current evidence-based standards for
foundational nursing practice, a systematic explanation of why each distractor is incorrect, and a
specific reference to the 2026 NUR 104 Excelsior University course module, foundational nursing
textbook chapter (Potter and Perry, Jarvis), or current clinical guideline from which the question
is derived. The examination emphasizes the practical application of the nursing process (ADPIE),
the NCSBN Clinical Judgment Measurement Model (CJMM), and the integration of theoretical
knowledge, clinical reasoning, and basic psychomotor skills required for safe, patient-centered
care across diverse clinical settings and patient populations.
Keywords
NUR 104, Excelsior University, Foundations of Nursing, Final Exam, Nursing Process, ADPIE,
Health Assessment, Infection Control, Patient Safety, Clinical Judgment, NGN
,Content Area Overview
Content Area Questions Key Topics Weight
Nursing Process & 1-20 ADPIE, CJMM, 20%
Clinical Judgment NANDA-I, SMART
goals, prioritization,
EBP
Health Assessment & 21-45 Vital signs, exam 25%
Vital Signs techniques, APGAR,
GCS, pain scales
Safety, Infection 46-70 Chain of infection, 25%
Control & Ethics PPE, isolation, ethics,
HIPAA, restraints
Basic Pharmacology 71-85 10 Rights, dosage 15%
& Medication Safety calc, controlled
substances,
pharmacokinetics
Professional 86-100 Therapeutic 15%
Communication & communication,
Documentation SBAR, EHR, cultural
competence
Examination Questions
Domain: Nursing Process & Clinical Judgment
Q1. A nurse is caring for a newly admitted patient with heart failure. Which action
represents the first step of the nursing process (ADPIE)?
A. Establishing goals for fluid balance
B. Collecting a comprehensive health history
C. Administering prescribed furosemide
D. Determining that fluid volume excess exists
Correct Answer: B. Collecting a comprehensive health history
Rationale: Assessment is the first step of the nursing process and involves systematically
collecting subjective and objective data to build a comprehensive patient database. Before
diagnosing, planning, or implementing, the nurse must gather information such as health
history, physical examination findings, and laboratory values. This database forms the
foundation for all subsequent clinical decisions and care planning.
Why Wrong: Establishing goals is the planning step, which occurs after assessment and diagnosis
are complete. Administering medications is implementation, which follows the planning step.
Determining fluid volume excess is diagnosis, which follows the assessment step.
Reference: Potter & Perry Fundamentals of Nursing, Chapter 3
Q2. According to the NCSBN Clinical Judgment Measurement Model (CJMM), a
nurse observes that a postoperative patient's respiratory rate increased from 16 to
28 breaths/min. Which CJMM step does this observation represent?
A. Recognize cues
B. Analyze cues
C. Take action
D. Evaluate outcomes
Correct Answer: A. Recognize cues
Rationale: Recognizing cues is the first layer of the NCSBN CJMM and involves identifying
relevant clinical information such as changes in vital signs from the patient's environment. The
, increased respiratory rate is a cue that warrants the nurse's attention before any further
interpretation. After recognizing the cue, the nurse would proceed to analyze its meaning and
clinical significance.
Why Wrong: Analyze cues involves comparing findings to expected ranges, which follows
recognition of the cue. Take action involves implementing interventions after solutions are
generated later in the model. Evaluate outcomes is the final step, assessing whether actions were
effective.
Reference: NCSBN CJMM Framework 2026
Q3. A nurse caring for a patient with a sodium level of 128 mEq/L notes new-onset
confusion and muscle weakness. In the NCSBN CJMM, comparing these findings to
expected values represents which step?
A. Recognize cues
B. Analyze cues
C. Prioritize hypotheses
D. Generate solutions
Correct Answer: B. Analyze cues
Rationale: Analyzing cues involves interpreting collected data by comparing findings to
expected values and the patient's baseline. The nurse links the hyponatremia to the symptoms of
confusion and weakness to determine clinical significance. This step bridges raw data
recognition and the prioritization of hypotheses.
Why Wrong: Recognize cues is identifying the data, which precedes the analysis step. Prioritize
hypotheses involves ranking possible explanations, which follows analysis of cues. Generate
solutions involves planning interventions, which comes later in the model.
Reference: NCSBN CJMM Framework 2026
Q4. A patient presents with acute dyspnea, wheezing, and an oxygen saturation of
88%. Using the NCSBN CJMM, ranking impaired gas exchange as the highest-
priority problem represents which step?
A. Recognize cues
B. Analyze cues
C. Prioritize hypotheses
D. Evaluate outcomes
Correct Answer: C. Prioritize hypotheses
Rationale: Prioritizing hypotheses involves ranking potential explanations or problems by
urgency and clinical significance. The nurse determines that impaired gas exchange is the most
immediate threat to the patient's life and addresses it first. This step guides which problem the
nurse takes action on before others.
Why Wrong: Recognize cues is identifying data, which occurs earlier in the model. Analyze cues is
interpreting data, which precedes the prioritization of hypotheses. Evaluate outcomes is assessing
results after intervention, the last step of the model.
Reference: NCSBN CJMM Framework 2026
Q5. A nurse identifies a patient at risk for falls. In the NCSBN CJMM, which step
includes identifying interventions such as bed alarms and hourly rounding?
A. Generate solutions
B. Take action
C. Recognize cues
D. Evaluate outcomes
Correct Answer: A. Generate solutions
Rationale: Generating solutions involves identifying appropriate interventions and a plan of
care to address the prioritized hypotheses. For fall risk, solutions include bed alarms, hourly
