NR226 / NR 226 Exam 2 2026/2027 Update | Fundamentals of Patient Care | Questions & Answers with Detailed Rationales | Grade A 100% Correct| Fundamentals of Nursing & NCLEX-RN® Prep PDF

INSTANT PDF DOWNLOAD — This is the comprehensive Exam 2 preparation guide for NR226 / NR 226 - Fundamentals of Patient Care (2026 Update), featuring questions and answers with detailed rationales. Designed for foundational nursing students, this resource consolidates the essential patient care concepts required to master the NR226 Exam 2 and excel in fundamentals of nursing. The guide is meticulously aligned with NCLEX-RN® test plan, QSEN competencies, and current evidence-based fundamental nursing practice standards. This verified resource provides comprehensive coverage of key NR226 Fundamentals of Patient Care Exam 2 topics, including: Basic Nursing Skills (vital signs measurement—temperature (oral, rectal, axillary, tympanic, temporal; normal ranges, fever patterns, hypothermia), pulse (rate (bradycardia 60, tachycardia 100), rhythm, amplitude (0-4+), apical pulse, peripheral pulses, pulse deficit), respirations (rate (eupnea 12-20, tachypnea 20, bradypnea 12), depth, rhythm, pattern (Cheyne-Stokes, Biot's, Kussmaul)), blood pressure (systolic/diastolic, Korotkoff sounds, auscultatory gap, hypertension (≥130/80), hypotension (SBP 90 or DBP 60), orthostatic hypotension (drop ≥20 SBP or ≥10 DBP upon standing)), pain assessment (PQRST, pain scales (numeric 0-10, Wong-Baker FACES, FLACC, PAINAD, CRIES)), pulse oximetry (SpO2 normal 95-100%, limitations, motion artifact, nail polish), oxygen delivery systems (nasal cannula (1-6 L/min, FiO2 24-44%), simple face mask (5-10 L/min, FiO2 35-50%), partial rebreather (6-11 L/min, FiO2 40-70%), non-rebreather (10-15 L/min, FiO2 80-95%), Venturi mask (precise FiO2 for COPD patients), high-flow nasal cannula (HFNC), face tent, tracheostomy collar), incentive spirometry (purpose: prevent atelectasis, procedure: sitting upright, inhale slowly to raise piston, hold 3-5 seconds, exhale, repeat 10 times per hour), suctioning (oropharyngeal, nasopharyngeal, endotracheal, tracheostomy—suction pressure 80-150 mm Hg, pre-oxygenate, limit suction time to 10-15 seconds, sterile technique for artificial airways), airway management (oropharyngeal airway (OPA—unconscious patients only), nasopharyngeal airway (NPA—conscious or unconscious), tracheostomy care (stoma care, inner cannula cleaning, tie changes, cuff management (pressure 20-30 cm H2O)), oxygen safety (no smoking/open flames near oxygen, no petroleum-based products, secure tanks, post signs), infection control (chain of infection (infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host), breaking the chain, medical asepsis (clean technique) vs surgical aseptic technique (sterile technique), standard precautions (hand hygiene (WHO 5 moments for hand hygiene, alcohol-based hand rub vs soap and water (C. diff requires soap and water)), PPE (gloves, gown, mask, eye protection, face shield), donning and doffing sequence (don: gown, mask, eye protection, gloves; doff: gloves, eye protection, gown, mask—hand hygiene between steps), transmission-based precautions—contact (private room or cohort, gloves, gown, dedicated equipment—MRSA, VRE, C. diff, RSV), droplet (private room, mask within 3 feet—influenza, pertussis, meningococcal), airborne (negative pressure AIIR, N95 respirator—TB, measles, varicella), protective environment (reverse isolation—immunocompromised), healthcare-associated infections (HAIs—CAUTI, CLABSI, VAP, SSI), multidrug-resistant organisms (MDROs—MRSA, VRE, CRE, ESBL, C. diff), hand hygiene compliance, environmental cleaning, sterile technique maintenance), patient safety (national patient safety goals (NPSGs)—The Joint Commission, two patient identifiers (name, DOB, medical record number—NOT room number or bed number), handoff communication (SBAR: Situation, Background, Assessment, Recommendation), medication safety (label all medications/solution containers, medication reconciliation), fall prevention (fall risk assessment tools (Morse Fall Scale, Hendrich II), interventions (bed alarm, chair alarm, nonslip socks, low bed, call light within reach, frequent rounding, toileting schedule, clutter-free environment, adequate lighting, handrails, bed in lowest position with brakes locked)), restraints (physical (vest, wrist, ankle, belt, geri-chair with tray) and chemical—criteria (imminent danger to self/others, less restrictive alternatives failed), physician order within 1 hour, face-to-face evaluation within 1 hour, time-limited (adults: 4 hours), continuous monitoring, documentation q15-30 minutes (vital signs, skin integrity, nutrition/hydration, elimination, ROM, circulation checks), debriefing after release, restraint-free environment goal), seizure precautions (padding side rails, oxygen and suction at bedside, bed in lowest position, IV access, rescue medications (benzodiazepines)), seizure first aid (protect from injury, turn to side, time seizure, do NOT put anything in mouth, do NOT restrain), fire safety (RACE: Rescue, Alarm, Contain/close doors, Extinguish/Evacuate; PASS: Pull pin, Aim at base of fire, Squeeze handle, Sweep side to side), equipment safety (IV pumps, bed alarms, suction equipment, oxygen tanks—no smoking near oxygen, secure tanks upright), mobility and immobility (effects of immobility (musculoskeletal—muscle atrophy, weakness, contractures, disuse osteoporosis, foot drop; cardiovascular—orthostatic hypotension, venous stasis, DVT, PE; respiratory—atelectasis, hypostatic pneumonia; GI—constipation, fecal impaction; urinary—UTI, urinary stasis, calculi, retention; integumentary—pressure injuries; metabolic—negative nitrogen balance, hypercalcemia; psychosocial—depression, anxiety, social isolation)), body mechanics (principles: center of gravity, base of support, leverage, friction, shear, ergonomic principles, lift with legs not back, keep load close to body, avoid twisting, pivot with feet), safe patient handling (mechanical lifts (Hoyer lift, sit-to-stand lift, ceiling lift), friction-reducing devices (slide sheets, roller boards, transfer boards), gait belt (transfer belt) use (apply snugly over clothing around waist, walker or cane if used, stand patient with wide base of support, pivot to chair/bed)), positioning techniques—supine (flat on back), prone (on stomach—contraindicated in spinal injuries, pregnancy, respiratory compromise), lateral/side-lying (pillow between knees, under head, behind back), Sim's (semi-prone, left side-lying with right knee flexed—enema administration), Fowler's (semi-Fowler's 15-30°, Fowler's 45-60°, high Fowler's 90°—respiratory distress, eating, tube feeding), Trendelenburg (head down, feet up—contraindicated in increased ICP, respiratory compromise), reverse Trendelenburg (head up, feet down—gastric reflux prevention), range of motion (ROM)—active (patient performs independently), passive (nurse moves joint through ROM), active-assistive (patient performs with assistance), ROM exercises per joint (neck, shoulder, elbow, forearm, wrist, fingers, thumb, hip, knee, ankle, toes), transfer techniques (bed to stretcher (friction-reducing slide board, 3-4 caregivers), bed to wheelchair (position wheelchair at 45° angle to bed on patient's strong side, lock brakes, raise footrests, pivot or use transfer board), mechanical lift for non-weight-bearing patients), ambulation assistance—walker (measure to wrist crease with patient standing upright), cane (hold on strong side, advance with weak leg, then strong leg), crutches (2-point, 3-point, 4-point gait, swing-to, swing-through—measure 2-3 finger widths below axilla to prevent axillary nerve compression), fall prevention during ambulation (gait belt, clear path, nonslip footwear, close supervision), skin integrity and wound care (skin layers—epidermis (avascular), dermis (vascular), subcutaneous tissue, pressure injury (formerly pressure ulcer)—pathophysiology (prolonged pressure capillary closing pressure (32 mm Hg) → ischemia → tissue hypoxia → cell death → necrosis), risk factors (immobility, decreased sensory perception, moisture, poor nutrition, friction and shear, advanced age, chronic conditions), pressure injury risk assessment scales—Braden Scale (6 subscales: sensory perception, moisture, activity, mobility, nutrition, friction/shear—score 6-23, lower score = higher risk, cutoff ≤18 for risk), Norton Scale, pressure injury staging (NPUAP)—Stage 1 (intact skin with non-blanchable erythema), Stage 2 (partial-thickness skin loss with exposed dermis, shallow open ulcer or intact/ruptured blister), Stage 3 (full-thickness skin loss, subcutaneous fat visible, no exposed bone/tendon/muscle, undermining/tunneling may occur), Stage 4 (full-thickness skin and tissue loss with exposed or palpable fascia, muscle, tendon, ligament, cartilage, or bone, undermining/tunneling common), Unstageable (obscured full-thickness skin and tissue loss—base covered by slough and/or eschar), Deep Tissue Pressure Injury (persistent non-blanchable deep red, maroon, purple discoloration or blood-filled blister), pressure injury prevention—turning and repositioning schedule (every 2 hours for bedridden, every 1 hour for chair-bound), support surfaces (pressure redistribution mattresses—foam, alternating pressure, low-air-loss, air-fluidized), positioning devices (pillows, foam wedges, heel offloading devices—donut devices NOT recommended), heel elevation, skin assessment daily (inspect high-risk areas—sacrum/coccyx, heels, greater trochanters, ischial tuberosities, elbows, occiput), moisture management (absorbent pads, moisture-barrier creams, incontinence briefs changed frequently, regular toileting schedule), nutritional support (high-protein diet, vitamin C, zinc, iron, adequate hydration), pressure injury treatment—wound cleansing (normal saline, non-cytotoxic cleansers—avoid hydrogen peroxide, povidone-iodine (toxic to granulation tissue)), debridement (sharp/surgical, enzymatic, autolytic (hydrogel, occlusive dressings), mechanical (wet-to-dry—not recommended as non-selective and painful)), dressing selection (Stage 1—transparent film, foam; Stage 2—hydrocolloid, foam, hydrogel; Stage 3/4—alginate, hydrofiber, foam, gauze (moist), negative pressure wound therapy (NPWT/VAC) for deep wounds with heavy exudate; antimicrobial dressings—silver, iodine, honey (Medihoney)), wound healing phases—hemostasis (immediate—platelet aggregation, clot formation), inflammatory (1-5 days—leukocyte infiltration, erythema, edema, heat, pain), proliferative (5-21 days—granulation tissue (red, moist, bumpy), angiogenesis, epithelialization, contraction), maturation/remodeling (21 days to 1-2 years—collagen remodeling, scar formation), wound healing types—primary intention (surgical incision, edges approximated), secondary intention (wound left open to heal from base up, granulation tissue fills defect), tertiary intention (delayed primary closure—wound left open initially for infection control then surgically closed), wound complications—infection (purulent drainage, erythema, warmth, pain, fever, delayed healing, malodor), dehiscence (partial or complete separation of wound layers), evisceration (protrusion of internal organs through wound—emergency: cover with sterile saline-moistened dressing, do not attempt to reinsert, NPO, prepare for surgery, monitor vital signs), fistula (abnormal connection between two body cavities or between cavity and skin), hemorrhage (bleeding from wound site—apply pressure, monitor vital signs), hematoma (localized collection of blood under skin), wound drainage types—serous (clear, watery), sanguineous (bright red, bloody), serosanguineous (pink, blood-tinged), purulent (thick, yellow, green, brown, odorous—indicates infection), medication administration (medication safety—five rights (right patient, drug, dose, route, time), additional rights (right documentation, reason, response, to refuse), medication reconciliation, medication administration record (MAR), routes of administration—oral (PO), sublingual (SL), buccal, topical, transdermal, ophthalmic, otic, nasal, inhaled, rectal, vaginal, subcutaneous (subQ), intramuscular (IM), intradermal (ID), intravenous (IV)), injection sites—deltoid (1-2 mL, 18-27 gauge, 5/8-1 inch), vastus lateralis (0.5-5 mL, 22-25 gauge, 5/8-1.5 inches), ventrogluteal (preferred for adults, 2-5 mL, 20-25 gauge, 1-1.5 inches), dorsogluteal (no longer recommended due to sciatic nerve proximity), Z-track method (for IM injections to prevent leakage and tissue irritation, displace skin laterally before injection, release after needle withdrawal), IV therapy—peripheral IV insertion (vein selection (cephalic, basilic, median cubital, dorsal hand veins), tourniquet application, site cleansing (chlorhexidine or alcohol), insertion angle 10-30 degrees, flashback indicates entry, advance catheter, withdraw needle, secure with dressing, flush with saline), site care (assess for complications (infiltration (coolness, swelling, pallor, leakage, pain), extravasation (vesicant medications cause tissue necrosis—stop infusion, aspirate, antidote per protocol), phlebitis (redness, warmth, tenderness, palpable cord), infection (purulent drainage, fever, chills)), IV push (administer slowly over 1-5 minutes depending on medication, flush between incompatible medications, monitor for adverse reactions), intermittent IV infusion (piggyback, secondary line, flush before and after), continuous IV infusion (primary line, rate by pump or gravity, monitor drip chamber, change tubing per facility policy (every 72-96 hours, sooner for blood, lipids, propofol)), dosage calculations (dimensional analysis, ratio-proportion, formula method (desired/have × volume), dose by weight (mg/kg), IV infusion rate (mL/hr), drop factor (gtt/min = (volume × drop factor)/time in minutes), macrodrip (10-20 gtt/mL), microdrip (60 gtt/mL), safe dose range (calculate ordered dose vs recommended range, hold and clarify if outside safe range), high-alert medications (insulin, heparin, opioids, potassium chloride (IV), neuromuscular blockers, chemotherapeutic agents, epidural/intrathecal medications