Fundamentals of Nursing Questions for the Prometric Exam 2026: 20 MCQs with Answers on the Nursing Process, Vital Signs, Documentation, Patient Safety, Falls, Pressure Injuries, Oxygen, Catheters, Nasogastric Tubes, Pain, Ethics and Delegation

Fundamentals of nursing and professional practice together make up about 15 to 20% of the registered nurse paper, 20 to 30 questions, the largest block after medical-surgical nursing. These are the questions experienced nurses think they cannot fail and then do, because the exam asks for the textbook sequence rather than the ward shortcut. This set covers the themes that recur across every Gulf nursing paper.

The nursing process and prioritisation

Question 1

The nurse has four patients at the start of a shift: a post-operative patient asking for pain relief, a patient with a saturation of 88% on oxygen, a patient due a routine dressing change, and a patient who wants to discuss discharge. Who is seen first?

1. The patient asking for pain relief
2. The patient with a saturation of 88%, because airway and breathing problems take priority over pain, routine care and teaching
3. The dressing change
4. The discharge discussion

Answer: B. Prioritisation follows ABC, then Maslow's hierarchy, then acute before chronic and actual before potential problems.

Question 2

Which statement is a correctly written nursing diagnosis in the NANDA format?

1. "Pneumonia related to infection"
2. "Ineffective airway clearance related to thick secretions as evidenced by coarse crackles and ineffective cough"
3. "Needs suctioning"
4. "Patient is non-compliant"

Answer: B. A nursing diagnosis names the human response, its related factor and the evidence; it never restates the medical diagnosis.

Question 3

Which is a correctly written, measurable patient goal?

1. "Patient will feel better."
2. "Patient will ambulate 20 metres with a walking frame twice daily by day 3 post-operatively."
3. "Nurse will encourage mobility."
4. "Patient will understand their condition."

Answer: B. Goals are patient-centred, specific, measurable and time-bound; the evaluation step compares outcomes with them.

Vital signs and assessment

Question 4

Which adult vital sign reading requires the nurse to escalate immediately?

1. Blood pressure 128/82, heart rate 76
2. Respiratory rate 8 per minute with drowsiness after an opioid dose
3. Temperature 37.4 °C
4. Heart rate 92 after walking

Answer: B. A respiratory rate below 10 with sedation suggests opioid toxicity: stop the opioid, support breathing, give naloxone per protocol and call for help. Respiratory rate is the most sensitive and most often omitted vital sign.

Question 5

When taking a blood pressure, which error gives a falsely high reading?

1. A cuff that is too large
2. A cuff that is too small, the arm below heart level, legs crossed, talking during measurement or a full bladder
3. The arm supported at heart level
4. Resting five minutes beforehand

Answer: B. The bladder of the cuff should encircle about 80% of the arm; a cuff that is too large reads falsely low.

Question 6

A patient's pulse oximeter reads 85% but the patient is pink, talking comfortably with a respiratory rate of 16. The nurse should first:

1. Start high-flow oxygen and call the arrest team
2. Assess the patient and check for causes of a false reading: cold fingers, nail polish, poor perfusion, movement, probe position, then confirm with another site or device
3. Document 85% and move on
4. Intubate

Answer: B. Treat the patient, not the monitor; but never dismiss a low reading in a patient who looks unwell. Carbon monoxide poisoning gives a falsely normal reading.

Communication and documentation

Question 7

The nurse calls the doctor about a deteriorating patient. The structured handover tool recommended is:

1. Describing events in the order they happened
2. SBAR: Situation, Background, Assessment, Recommendation, stating clearly what the nurse needs the doctor to do and within what time
3. Sending a text message
4. Waiting for the ward round

Answer: B. Structured communication at handover and escalation is a Joint Commission International standard that Gulf hospitals audit.

Question 8

The nurse makes an error in a paper record. The correct correction is:

1. Erase it or use correction fluid
2. Draw a single line through the entry, write "error" or "written in error," initial, date and time it, and write the correct entry; electronic records are amended through the system's audit-trailed correction function
3. Tear out the page
4. Write over the entry in darker ink

Answer: B. Documentation is legal evidence; never document care before it is given, never document for another nurse, and never leave blank lines.

Question 9

A doctor gives a telephone order for a medication during the night. The nurse should:

1. Administer it and ask the doctor to sign tomorrow if they remember
2. Write the order down, read it back in full including drug, dose, route and frequency, confirm the patient's identity, have a second nurse witness where policy requires, document it as a verbal order with the prescriber's name, and ensure it is countersigned within the policy timeframe (usually 24 hours)
3. Refuse all telephone orders
4. Give the drug from memory

Answer: B. Verbal orders are limited to urgent situations; chemotherapy and some high-alert drugs are never accepted verbally.

Patient safety

Question 10

Before administering a medication, the nurse identifies the patient using:

1. The bed number
2. At least two identifiers, such as full name and medical record number or date of birth, checked against the wristband and the medication record, never the room or bed number
3. Asking "Are you Mr Ahmed?"
4. Recognising the patient's face

Answer: B. Patient identification is the first International Patient Safety Goal; the rights of medication administration (right patient, drug, dose, route, time, documentation, reason, response, to refuse) are tested with it.

Question 11

An 82-year-old with a recent stroke and nocturia is admitted. The most effective falls-prevention plan is:

1. Bed rails up on all four sides
2. A falls risk assessment on admission and after any change, bed in the low position with the call bell and belongings in reach, non-slip footwear, scheduled toileting, adequate lighting, medication review for sedatives and antihypertensives, and mobility aids within reach; four full rails are a restraint and increase injury
3. Sedation at night
4. Keeping the patient in bed all day

Answer: B. Falls are the most common inpatient incident; restraint and immobility increase deconditioning and injury.

Question 12

A bed-bound patient has a 2 cm area over the sacrum where the skin is intact but non-blanching red. The pressure injury stage and action are:

1. Stage 3; surgical referral
2. Stage 1; relieve pressure immediately with repositioning at least every 2 hours, a pressure-redistributing mattress, keeping the skin clean and dry, optimising nutrition and hydration, and reassessing with a validated tool such as Braden
3. Normal; no action
4. Deep tissue injury; debridement

Answer: B. Stage 2 is partial-thickness skin loss, stage 3 full-thickness with visible fat, stage 4 exposed bone, tendon or muscle; unstageable means slough or eschar obscures the depth. Massage over bony prominences is avoided.

Question 13

Which oxygen delivery device gives the most precise fractional inspired oxygen for a patient with COPD who needs controlled oxygen?

1. A simple face mask at 5 L/min
2. A Venturi mask at the prescribed percentage (for example 24 or 28%), titrated to saturations of 88 to 92%
3. A non-rebreather mask at 15 L/min
4. Nasal cannula at 6 L/min

Answer: B. A non-rebreather delivers 60 to 90% for emergencies; a simple mask needs at least 5 L/min to clear exhaled carbon dioxide; nasal cannulae give 24 to 40% at 1 to 6 L/min.

Tubes, lines and transfusion

Question 14

Which practice reduces catheter-associated urinary tract infection?

1. Routine catheter change every week
2. Inserting only when indicated, aseptic technique, a closed drainage system kept below the bladder and off the floor, securing the catheter, daily review of need with prompt removal, and perineal hygiene; routine bladder irrigation and antibiotics are not used
3. Disconnecting the bag for specimen collection
4. Keeping the bag above the bladder when the patient walks

Answer: B. Specimens are taken aseptically from the sampling port; the catheter balloon is deflated fully before removal.

Question 15

Before each use of a nasogastric tube for feeding, the nurse confirms position by:

1. The whoosh test with auscultation
2. Aspirating gastric contents and checking pH, with a pH of 1 to 5.5 confirming gastric placement; if aspirate cannot be obtained or pH is above 5.5, hold the feed and arrange a radiograph per policy, especially after insertion, coughing or vomiting
3. Placing the end in water to look for bubbles
4. Asking the patient if it feels right

Answer: B. Auscultation and bubbling tests are unreliable and no longer accepted; proton pump inhibitors can raise gastric pH.

Question 16

Fifteen minutes into a red cell transfusion, the patient develops fever, chills, back pain, hypotension and dark urine. The nurse's first actions are:

1. Slow the transfusion and give paracetamol
2. Stop the transfusion immediately, keep the line open with normal saline using a new giving set, check vital signs, re-check the patient and unit identification, notify the doctor and blood bank, return the unit and tubing, and collect blood and urine samples as directed, because this is a suspected acute haemolytic reaction
3. Continue and observe
4. Give an antihistamine and continue

Answer: B. Most fatal reactions come from identification errors at the bedside; two-person checks, observation within the first 15 minutes and completing red cells within 4 hours of leaving storage are the standards.

Pain, ethics and professional practice

Question 17

A post-operative patient rates pain 8 out of 10 but is laughing with visitors. The nurse should:

1. Document the pain as 3 because the patient looks comfortable
2. Accept the patient's self-report as the most reliable indicator of pain, assess further (site, character, aggravating factors), administer prescribed analgesia and reassess within 30 to 60 minutes
3. Withhold analgesia until the patient looks uncomfortable
4. Tell the patient they cannot be in that much pain

Answer: B. Coping behaviours such as distraction do not disprove pain; cultural expression of pain varies widely in a multinational Gulf patient population.

Question 18

A patient asks the nurse not to tell their family about a diagnosis of hepatitis B. A family member later asks the nurse for the diagnosis. The nurse should:

1. Tell the family because they are close relatives
2. Maintain confidentiality, explain that information can be shared only with the patient's consent, and encourage the patient to involve the family if they wish; disclosure without consent is allowed only where the law requires it (for example notifiable disease reporting to public health)
3. Hint at the diagnosis
4. Post it on the whiteboard

Answer: B. Gulf health data laws and licensing codes of conduct treat confidentiality breaches as professional misconduct.

Question 19

Which task can the registered nurse appropriately delegate to a trained assistant nurse or nursing aide?

1. Initial assessment of a newly admitted patient
2. Measuring and recording vital signs on a stable patient, assisting with hygiene and mobilisation, and recording intake and output, with the registered nurse remaining accountable for supervision and for interpreting the findings
3. Administering intravenous medication
4. Patient education about a new insulin regimen

Answer: B. Assessment, planning, evaluation, teaching and tasks requiring nursing judgement are not delegated; the five rights of delegation are the right task, circumstance, person, direction and supervision.

Question 20

The nurse realises a patient received another patient's oral antihypertensive two hours ago. The patient is asymptomatic. The nurse should:

1. Say nothing since no harm has occurred
2. Assess and monitor the patient, notify the prescriber and the nurse in charge, inform the patient honestly, document the facts objectively in the record, and complete an incident report through the hospital's reporting system so the cause can be analysed
3. Document that the correct drug was given
4. Report only if the patient becomes unwell

Answer: B. Incident reports are non-punitive quality tools in a just culture; concealing an error is the professional offence, not the error itself.

How to practise

• Answer as the textbook does, not as the ward does: full sequences, two identifiers, read-back, pH checks.
• Learn the safety standards Gulf hospitals audit: International Patient Safety Goals, falls, pressure injury staging, transfusion checks, documentation rules.
• Practise prioritisation: ABC first, then Maslow, then acute over chronic.

Fundamentals chapters with explanations are in the Registered Nurse bank; assistant nurses sit the Assistant Nurse paper. Related sets are the infection control questions, drug calculation questions and general nursing questions. The plan is in DHA nursing exam preparation online.

Frequently asked questions

How many fundamentals questions are in the Prometric nursing exam?

Fundamentals and professional practice together are about 20 to 30 of 150, the second-largest block after medical-surgical nursing.

Which fundamentals topics come up most?

Prioritisation, patient identification and medication rights, documentation and verbal orders, falls and pressure injuries, oxygen devices, catheters and nasogastric tubes, transfusion reactions and delegation.

Why do experienced nurses lose marks on fundamentals?

Because the exam wants the complete textbook procedure, and ward habits (bed numbers, auscultation for NG tubes, skipping read-back) are the wrong answers.

Are ethics and law tested?

Yes, at the level of consent, confidentiality, refusal of treatment, incident reporting and professional accountability.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.