Fundamentals of Nursing – RN Practice Questions

These practice questions cover Fundamentals of Nursing at registered nurse level, with emphasis on assessment, care planning, prioritization across a group of patients, delegation, and evaluation of outcomes. Answers are given by option number as the list renders on the page.

Question 1

A registered nurse begins the shift on a medical unit. Which patient should the nurse assess first?

1. A 68 year old with chronic osteoarthritis who rates hip pain at 7 out of 10 and is due for a scheduled analgesic.
2. A 74 year old admitted yesterday for pneumonia whose family reports the patient is now confused and pulling at the intravenous line.
3. A 52 year old two days after a colon resection who has not had a bowel movement since surgery.
4. A 45 year old with a stage 2 sacral pressure injury who is due for a dressing change.

Answer: 2. The 74 year old with new onset confusion.

Rationale: New onset confusion is an acute, unexpected change from baseline and is frequently the earliest sign of hypoxia, sepsis, hypoglycemia, or another physiologic deterioration. It also creates an immediate safety risk, since the patient is pulling at lines. Airway, breathing, and circulation concerns and unexpected changes outrank expected findings. Option 1 is significant pain but it is chronic and expected, and the medication is scheduled. Option 3 is an expected postoperative finding at 48 hours and is not urgent. Option 4 is a scheduled task that can wait.

Question 2

The registered nurse is planning assignments for a team that includes a licensed practical nurse and assistive personnel. Which tasks may the nurse delegate to the assistive personnel? Select all that apply.

1. Measuring and recording vital signs on a stable patient two days after hip replacement.
2. Assisting a patient with a shower who ambulates independently.
3. Reinforcing discharge teaching about a low sodium diet.
4. Recording oral intake and urine output on a patient with a stable fluid balance.
5. Performing the admission assessment on a newly arrived patient.
6. Applying sequential compression devices as prescribed.

Answer: 1, 2, 4, and 6.

Rationale: Assistive personnel may perform standard, unchanging tasks with predictable outcomes for stable patients, including measuring vital signs, assisting with hygiene, recording intake and output, and applying compression devices. The nurse must still verify and interpret any values reported. Option 3 is incorrect because teaching, including reinforcement of teaching, requires a licensed nurse; a licensed practical nurse may reinforce teaching the registered nurse initiated, but assistive personnel may not. Option 5 is incorrect because the admission assessment requires nursing judgment and is a registered nurse responsibility that cannot be delegated.

Question 3

A registered nurse is writing a care plan for a patient recovering from a stroke with left sided weakness. Which statement is correctly written as an expected outcome?

1. The nurse will ambulate the patient in the hallway twice daily.
2. Impaired physical mobility related to left sided hemiparesis.
3. The patient will transfer from bed to chair with a gait belt and one person assist by hospital day three.
4. The patient will improve mobility as soon as possible.

Answer: 3. The patient will transfer from bed to chair with a gait belt and one person assist by hospital day three.

Rationale: An expected outcome is patient centered, specific, measurable, realistic, and time limited. Option 3 names the patient behavior, the conditions, and a deadline. Option 1 describes a nursing intervention, not a patient outcome. Option 2 is a nursing diagnosis, which belongs to the analysis step rather than the planning step. Option 4 is not measurable and has no time frame, so it cannot be evaluated.

Question 4

A patient receiving continuous enteral tube feeding is found lying flat in bed. What is the nurse's priority action?

1. Stop the feeding and notify the provider.
2. Check the gastric residual volume.
3. Raise the head of the bed to at least 30 degrees.
4. Auscultate the lungs for adventitious sounds.

Answer: 3. Raise the head of the bed to at least 30 degrees.

Rationale: A patient lying flat during enteral feeding is at immediate risk for reflux and aspiration. The priority is to eliminate the hazard by elevating the head of the bed to at least 30 degrees, and preferably 30 to 45 degrees, and keeping it elevated for 30 to 60 minutes after the feeding. This is an emergency style situation where the required action is obvious and immediate, so it precedes further assessment. Options 2 and 4 are appropriate follow up assessments after the patient is made safe. Option 1 is premature; there is no indication yet to stop the feeding or call the provider.

Question 5

The nurse enters the room of a patient using intravenous patient controlled analgesia and finds the patient's spouse pressing the dose button while the patient sleeps. What is the nurse's best initial response?

1. Document the finding and continue monitoring the patient.
2. Explain that only the patient may press the button and assess the patient's sedation and respiratory status.
3. Remove the patient controlled analgesia device and notify the provider.
4. Reassure the spouse that this is acceptable if the patient is in pain.

Answer: 2. Explain that only the patient may press the button and assess the patient's sedation and respiratory status.

Rationale: Patient controlled analgesia is safe because a sedated patient cannot press the button, so the patient's own level of consciousness limits the dose. Proxy dosing by family or staff removes that safeguard and can cause oversedation and respiratory depression. The nurse must both stop the unsafe behavior with education and immediately evaluate the patient for sedation, which precedes respiratory depression. Option 1 fails to correct the hazard. Option 3 is excessive as an initial action and would leave the patient without analgesia. Option 4 is unsafe and factually wrong.

Question 6

A registered nurse is evaluating outcomes for a patient whose goal was to ambulate 100 feet with a walker by postoperative day three. On day three the patient ambulates 40 feet and stops because of fatigue. What should the nurse do next?

1. Document that the outcome was met.
2. Discontinue the goal because the patient cannot achieve it.
3. Reassess the patient and revise the plan of care.
4. Delegate ambulation to assistive personnel more frequently.

Answer: 3. Reassess the patient and revise the plan of care.

Rationale: Evaluation determines whether an outcome was met, partially met, or not met. When an outcome is only partially met, the nurse returns to assessment to identify why, such as pain, anemia, deconditioning, or hypoxia, and then revises the diagnosis, the outcome, or the interventions. The nursing process is cyclical. Option 1 is inaccurate documentation. Option 2 abandons a reasonable goal rather than adjusting it. Option 4 is an intervention chosen before the cause is understood, and ambulation frequency may not be the problem.

Question 7

Which findings should the nurse report as indicating a positive orthostatic blood pressure test? Select all that apply.

1. A fall in systolic blood pressure from 132 to 108 millimeters of mercury on standing.
2. A fall in diastolic blood pressure from 78 to 74 millimeters of mercury on standing.
3. The patient reports dizziness and blurred vision on standing.
4. A rise in heart rate from 76 to 82 beats per minute on standing.
5. A fall in systolic blood pressure from 140 to 128 millimeters of mercury on standing.
6. A fall in diastolic blood pressure from 84 to 72 millimeters of mercury on standing.

Answer: 1, 3, and 6.

Rationale: Orthostatic hypotension is defined by a drop of at least 20 millimeters of mercury in systolic pressure or at least 10 millimeters of mercury in diastolic pressure within three minutes of standing, or by symptoms such as dizziness, lightheadedness, or visual changes. Option 1 is a 24 point systolic drop and option 6 is a 12 point diastolic drop, both qualifying. Option 3 is symptomatic and clinically significant regardless of the numbers. Option 2 is a 4 point drop and option 5 is a 12 point systolic drop, neither of which meets the systolic or diastolic threshold. Option 4 is a normal compensatory heart rate response.

Question 8

The nurse is preparing to administer digoxin to an adult patient. The apical pulse is 54 beats per minute and irregular. What is the nurse's priority action?

1. Administer the dose and recheck the pulse in one hour.
2. Hold the dose, notify the provider, and document the finding.
3. Administer half of the prescribed dose.
4. Check the radial pulse in the opposite arm before deciding.

Answer: 2. Hold the dose, notify the provider, and document the finding.

Rationale: The standard practice is to assess the apical pulse for one full minute before giving digoxin and to hold the dose in an adult if the rate is below 60 beats per minute, because digoxin slows conduction and further bradycardia may indicate toxicity. The nurse holds the medication, notifies the provider, and documents. Option 1 risks worsening bradycardia and heart block. Option 3 is outside nursing scope; a nurse may not alter a prescribed dose. Option 4 is not the deciding measurement, since the apical rate is the standard for digoxin and is the more accurate value in an irregular rhythm.

Question 9

An older adult who has been immobile for several days and receiving opioids reports frequent small amounts of liquid brown stool. Which action should the nurse take first?

1. Administer the prescribed antidiarrheal medication.
2. Increase oral fluids and add fiber to the diet.
3. Perform a focused abdominal and digital rectal assessment.
4. Place the patient on contact precautions for suspected infection.

Answer: 3. Perform a focused abdominal and digital rectal assessment.

Rationale: Liquid stool leaking around a hardened mass is the classic presentation of fecal impaction, a predictable consequence of immobility and opioid therapy. Assessment must come before intervention, and a focused abdominal and rectal examination identifies the impaction. Option 1 would worsen an impaction and is contraindicated until infection and impaction are ruled out. Option 2 is reasonable prevention but does not address the current problem and delays identification. Option 4 may become appropriate if infectious diarrhea is suspected, but the history here points strongly to impaction, and precautions are not the first assessment step.

Question 10

Which nursing interventions reduce the risk of catheter associated urinary tract infection? Select all that apply.

1. Keeping the drainage bag below the level of the bladder at all times.
2. Reviewing the continued need for the catheter daily and removing it as soon as possible.
3. Routinely irrigating the catheter with sterile saline every shift.
4. Securing the catheter tubing to the patient's thigh to prevent traction.
5. Obtaining urine specimens from the sampling port using aseptic technique.
6. Disconnecting the tubing from the bag to allow easier patient transfer.

Answer: 1, 2, 4, and 5.

Rationale: Duration of catheterization is the strongest single risk factor for catheter associated urinary tract infection, so daily review and early removal matter most. Keeping the bag below the bladder prevents backflow of contaminated urine, securing the tubing prevents urethral trauma, and sampling from the port preserves the closed system. Option 3 is incorrect because routine irrigation is not recommended and breaks the closed system. Option 6 is incorrect for the same reason; the closed drainage system must be maintained, and disconnection introduces organisms directly into the system.

Question 11

The nurse observes assistive personnel providing morning care. Which observation requires the nurse to intervene?

1. The assistive personnel washes the patient's eye from the inner canthus to the outer canthus.
2. The assistive personnel returns the foreskin to its natural position after cleaning an uncircumcised patient.
3. The assistive personnel briskly massages a reddened area over the patient's sacrum to stimulate circulation.
4. The assistive personnel dries thoroughly between the patient's toes and applies lotion to the top of the foot.

Answer: 3. Massaging a reddened area over the sacrum.

Rationale: Massage over a reddened bony prominence is contraindicated, because the underlying tissue is already damaged and friction plus shear can deepen the injury. The nurse must stop this immediately and reinforce correct pressure injury prevention. Option 1 is correct technique, which prevents transfer of organisms toward the lacrimal duct. Option 2 is essential, since failure to reduce the foreskin can cause paraphimosis and vascular compromise. Option 4 is correct, since moisture between the toes promotes maceration and fungal infection, while lotion elsewhere prevents cracking.

Question 12

A patient with a new ileostomy is being evaluated by the nurse. Which finding requires immediate provider notification?

1. The stoma is beadlike, moist, and pink to red.
2. The pouch contains 400 milliliters of liquid to pasty effluent over eight hours.
3. The stoma appears dusky purple with no visible bleeding when touched.
4. The patient reports feeling embarrassed and does not want to look at the stoma.

Answer: 3. The stoma appears dusky purple with no visible bleeding when touched.

Rationale: A healthy stoma is pink to red, moist, and slightly raised, and it bleeds slightly with cleansing because it is vascular mucosa. A dusky, purple, or black stoma indicates ischemia and possible necrosis, which is a surgical emergency and must be reported immediately. Option 1 describes a normal stoma. Option 2 describes expected ileostomy output, which is liquid to pasty; the nurse monitors for dehydration and electrolyte loss but this is not an emergency. Option 4 is a common and expected psychosocial response requiring support and gradual education, not urgent notification.

Question 13

Which actions should the nurse take when a confused patient at high risk for falls repeatedly attempts to climb out of bed? Select all that apply.

1. Move the patient to a room near the nurses' station for closer observation.
2. Raise all four side rails to keep the patient in bed.
3. Implement hourly rounding that addresses pain, position, toileting needs, and possessions.
4. Place the bed in the lowest position with the wheels locked and use a bed exit alarm.
5. Apply soft wrist restraints as needed for restlessness.
6. Ensure nonskid footwear and adequate lighting including a night light.

Answer: 1, 3, 4, and 6.

Rationale: Least restrictive interventions come first. Increased visibility, hourly rounding that meets the underlying needs driving the behavior, a low locked bed with an exit alarm, and environmental measures are all evidence based fall precautions. Option 2 is incorrect because four raised side rails constitute a restraint and also increase injury severity if the patient climbs over them. Option 5 is incorrect on two counts: restraints are a last resort only after less restrictive measures fail, and restraints may never be prescribed on an as needed basis.

Question 14

The nurse is assessing pain in a patient with advanced dementia who cannot provide a self report. Which assessment approach is most appropriate?

1. Assume the patient is not in pain because no complaint is made.
2. Use the Wong Baker FACES scale and ask the patient to point.
3. Use a validated behavioral observation tool such as PAINAD and consider a trial of analgesia.
4. Rely on vital signs alone, since elevated heart rate and blood pressure confirm pain.

Answer: 3. Use a validated behavioral observation tool such as PAINAD and consider a trial of analgesia.

Rationale: When a patient cannot self report, the nurse uses a validated observational tool that scores behaviors such as breathing, vocalization, facial expression, body language, and consolability, and considers a diagnostic analgesic trial with reassessment of behavior. Option 1 is unsafe, since inability to report is not absence of pain, and untreated pain in dementia often presents as agitation. Option 2 requires cognitive ability to match a face to an internal state, which is generally unreliable in advanced dementia. Option 4 is wrong because vital signs are neither sensitive nor specific for pain and often normalize in persistent pain.

Question 15

A registered nurse is supervising a licensed practical nurse on a medical unit. Which patient assignment is most appropriate for the licensed practical nurse?

1. A patient admitted one hour ago with chest pain who needs an admission assessment.
2. A stable patient three days after abdominal surgery who requires a sterile dressing change and reinforcement of previously taught incision care.
3. A newly diagnosed patient with diabetes who requires initial insulin self administration teaching.
4. A patient whose condition has changed and who requires revision of the plan of care.

Answer: 2. The stable postoperative patient requiring a sterile dressing change and reinforcement of teaching.

Rationale: Licensed practical nurses care for stable patients with predictable outcomes, perform sterile dressing changes within their scope, and reinforce teaching that the registered nurse has already initiated. Option 1 requires the initial comprehensive assessment of an unstable, newly admitted patient, which is a registered nurse responsibility. Option 3 requires initial teaching, which the registered nurse must provide. Option 4 requires evaluation and revision of the plan of care, which cannot be delegated. Scope specifics vary by state nurse practice act and facility policy.

This page is independent study material for nursing licensure exam preparation. NCLEX-RN® and NCLEX-PN® are registered trademarks of the National Council of State Boards of Nursing (NCSBN). This content is not produced, reviewed, or endorsed by NCSBN. Always verify clinical information against current facility policy, drug references, and your nursing program's curriculum before applying it in practice.