NSG 3100 EXAM 2 FUNDAMENTALS CONCEPT AND SKILLS FOR NURSING
EXAM – QUESTIONS AND ANSWERS | EXAM TESTBANK WITH VERIFIED AND
WELL DETAILED ANSWERS | PLUS RATIONALES | DOWNLOAD AND PASS |
LATEST EXAM UPDATE 2026/2027
Core Domains
Patient Safety and Infection Control
Vital Signs and Physical Assessment
Mobility and Immobility
Hygiene and Personal Care
Medication Administration and Dosage Calculation
Oxygenation and Respiratory Function
Nutrition, Fluid, and Electrolyte Balance
Legal, Ethical, and Professional Standards in Nursing
Wound Care and Skin Integrity
Perioperative and Surgical Nursing Care
Introduction
This comprehensive examination is designed to evaluate the foundational
knowledge and clinical skills essential for the professional nursing practice of the
beginning practitioner. The assessment encompasses a wide range of concepts, from
theoretical principles to applied skills, focusing on patient-centered care, safety, and
clinical decision-making. Through a combination of multiple-choice and scenario-
based questions, this exam challenges the student to integrate knowledge from
various domains, including pathophysiology, pharmacology, and nursing
interventions. Emphasis is placed on real-world application, ethical and legal
considerations, and the ability to prioritize care in complex situations to ensure
patient safety and positive outcomes. The questions are structured to reflect the
,depth and breadth of the nursing curriculum, preparing students for both licensure
examinations and the demands of the clinical environment.
Section One: Questions 1 – 50
1. A nurse is preparing to administer a subcutaneous injection of heparin to a
patient. Which of the following actions is most appropriate to minimize the risk
of tissue damage?
A. Administer the injection in the deltoid muscle.
B. Use the Z-track method for administration.
C. Apply firm pressure and massage the site for one minute after injection.
D. Insert the needle at a 45- to 90-degree angle into a pinched skinfold.
🟢 Correct Answer: D. Insert the needle at a 45- to 90-degree angle into a
pinched skinfold.
🔴 Explanation: Subcutaneous injections, such as heparin, should be
administered into the subcutaneous tissue by pinching the skin and inserting the
needle at a 45- to 90-degree angle to ensure the medication is delivered to the
appropriate layer. The deltoid is not a standard site for subcutaneous heparin. The
Z-track method is used for intramuscular injections. Massaging the site is
contraindicated for heparin as it can increase the risk of hematoma formation.
2. A patient has an order for 500 mL of 0.9% Normal Saline to infuse over 4
hours. The drop factor of the IV tubing is 15 gtt/mL. What is the flow rate in
drops per minute (gtt/min)?
A. 31 gtt/min
B. 125 gtt/min
C. 21 gtt/min
D. 83 gtt/min
🟢 Correct Answer: A. 31 gtt/min
,🔴 Explanation: To calculate the flow rate: Total volume (500 mL) / Total time (4
hours x 60 min = 240 minutes) = 2.08 mL/min. Then multiply by the drop factor
(2.08 mL/min x 15 gtt/mL) = 31.25, which rounds down to 31 gtt/min.
3. Which of the following is the most reliable indicator of pain in a non-verbal,
3-year-old child?
A. Parental report of the child's behavior.
B. The child's facial expressions and body movements.
C. The child's ability to be distracted by toys.
D. An elevated heart rate and blood pressure.
🟢 Correct Answer: B. The child's facial expressions and body movements.
🔴 Explanation: In non-verbal children, behavioral assessment using tools like the
FLACC scale (Face, Legs, Activity, Cry, Consolability) is the most reliable method
for evaluating pain. Facial expressions and body movements are primary
indicators. Parental report is helpful but should be corroborated with direct
observation. Distraction does not rule out pain. Vital signs can be elevated due to
pain but are not specific or reliable.
4. A patient is on fall precautions. Which of the following nursing actions is a
priority for this patient?
A. Keep all four side rails up at all times.
B. Place the bed in the lowest position with the brakes locked.
C. Place the call light within reach and encourage the patient to use it.
D. Assign a nursing assistant to stay with the patient at all times.
🟢 Correct Answer: B. Place the bed in the lowest position with the brakes locked.
🔴 Explanation: The priority for fall prevention is to maintain the bed in the
lowest position with the brakes locked to minimize injury if the patient attempts
to get out of bed. Keeping all four side rails up is considered a restraint and
requires a specific order. While placing the call light within reach is important, it is
, a secondary intervention. Constant supervision is not indicated for all patients on
fall precautions and is a more restrictive intervention.
5. A nurse is assessing a patient's surgical wound on the second day post-
operation. Which of the following findings indicates a normal inflammatory
response?
A. Greenish-yellow purulent drainage from the incision site.
B. The wound edges are approximated with slight erythema and edema.
C. The patient reports increasing pain at the incision site.
D. The wound has a foul odor.
🟢 Correct Answer: B. The wound edges are approximated with slight erythema
and edema.
🔴 Explanation: Slight erythema (redness) and edema (swelling) are hallmarks of
the normal inflammatory response, indicating that the body is healing. Purulent
drainage, increasing pain, and foul odor are signs of infection, not normal healing,
and require immediate intervention.
6. A patient is experiencing hypoxia. The nurse would expect to see which of
the following early signs?
A. Cyanosis of the nail beds.
B. Restlessness and confusion.
C. Bradypnea.
D. Decreased blood pressure.
🟢 Correct Answer: B. Restlessness and confusion.
🔴 Explanation: The central nervous system is highly sensitive to oxygen
deprivation. Early signs of hypoxia include restlessness, confusion, and anxiety.
Cyanosis is a late sign. Tachypnea (not bradypnea) is an early compensatory
response, and blood pressure may initially increase.
EXAM – QUESTIONS AND ANSWERS | EXAM TESTBANK WITH VERIFIED AND
WELL DETAILED ANSWERS | PLUS RATIONALES | DOWNLOAD AND PASS |
LATEST EXAM UPDATE 2026/2027
Core Domains
Patient Safety and Infection Control
Vital Signs and Physical Assessment
Mobility and Immobility
Hygiene and Personal Care
Medication Administration and Dosage Calculation
Oxygenation and Respiratory Function
Nutrition, Fluid, and Electrolyte Balance
Legal, Ethical, and Professional Standards in Nursing
Wound Care and Skin Integrity
Perioperative and Surgical Nursing Care
Introduction
This comprehensive examination is designed to evaluate the foundational
knowledge and clinical skills essential for the professional nursing practice of the
beginning practitioner. The assessment encompasses a wide range of concepts, from
theoretical principles to applied skills, focusing on patient-centered care, safety, and
clinical decision-making. Through a combination of multiple-choice and scenario-
based questions, this exam challenges the student to integrate knowledge from
various domains, including pathophysiology, pharmacology, and nursing
interventions. Emphasis is placed on real-world application, ethical and legal
considerations, and the ability to prioritize care in complex situations to ensure
patient safety and positive outcomes. The questions are structured to reflect the
,depth and breadth of the nursing curriculum, preparing students for both licensure
examinations and the demands of the clinical environment.
Section One: Questions 1 – 50
1. A nurse is preparing to administer a subcutaneous injection of heparin to a
patient. Which of the following actions is most appropriate to minimize the risk
of tissue damage?
A. Administer the injection in the deltoid muscle.
B. Use the Z-track method for administration.
C. Apply firm pressure and massage the site for one minute after injection.
D. Insert the needle at a 45- to 90-degree angle into a pinched skinfold.
🟢 Correct Answer: D. Insert the needle at a 45- to 90-degree angle into a
pinched skinfold.
🔴 Explanation: Subcutaneous injections, such as heparin, should be
administered into the subcutaneous tissue by pinching the skin and inserting the
needle at a 45- to 90-degree angle to ensure the medication is delivered to the
appropriate layer. The deltoid is not a standard site for subcutaneous heparin. The
Z-track method is used for intramuscular injections. Massaging the site is
contraindicated for heparin as it can increase the risk of hematoma formation.
2. A patient has an order for 500 mL of 0.9% Normal Saline to infuse over 4
hours. The drop factor of the IV tubing is 15 gtt/mL. What is the flow rate in
drops per minute (gtt/min)?
A. 31 gtt/min
B. 125 gtt/min
C. 21 gtt/min
D. 83 gtt/min
🟢 Correct Answer: A. 31 gtt/min
,🔴 Explanation: To calculate the flow rate: Total volume (500 mL) / Total time (4
hours x 60 min = 240 minutes) = 2.08 mL/min. Then multiply by the drop factor
(2.08 mL/min x 15 gtt/mL) = 31.25, which rounds down to 31 gtt/min.
3. Which of the following is the most reliable indicator of pain in a non-verbal,
3-year-old child?
A. Parental report of the child's behavior.
B. The child's facial expressions and body movements.
C. The child's ability to be distracted by toys.
D. An elevated heart rate and blood pressure.
🟢 Correct Answer: B. The child's facial expressions and body movements.
🔴 Explanation: In non-verbal children, behavioral assessment using tools like the
FLACC scale (Face, Legs, Activity, Cry, Consolability) is the most reliable method
for evaluating pain. Facial expressions and body movements are primary
indicators. Parental report is helpful but should be corroborated with direct
observation. Distraction does not rule out pain. Vital signs can be elevated due to
pain but are not specific or reliable.
4. A patient is on fall precautions. Which of the following nursing actions is a
priority for this patient?
A. Keep all four side rails up at all times.
B. Place the bed in the lowest position with the brakes locked.
C. Place the call light within reach and encourage the patient to use it.
D. Assign a nursing assistant to stay with the patient at all times.
🟢 Correct Answer: B. Place the bed in the lowest position with the brakes locked.
🔴 Explanation: The priority for fall prevention is to maintain the bed in the
lowest position with the brakes locked to minimize injury if the patient attempts
to get out of bed. Keeping all four side rails up is considered a restraint and
requires a specific order. While placing the call light within reach is important, it is
, a secondary intervention. Constant supervision is not indicated for all patients on
fall precautions and is a more restrictive intervention.
5. A nurse is assessing a patient's surgical wound on the second day post-
operation. Which of the following findings indicates a normal inflammatory
response?
A. Greenish-yellow purulent drainage from the incision site.
B. The wound edges are approximated with slight erythema and edema.
C. The patient reports increasing pain at the incision site.
D. The wound has a foul odor.
🟢 Correct Answer: B. The wound edges are approximated with slight erythema
and edema.
🔴 Explanation: Slight erythema (redness) and edema (swelling) are hallmarks of
the normal inflammatory response, indicating that the body is healing. Purulent
drainage, increasing pain, and foul odor are signs of infection, not normal healing,
and require immediate intervention.
6. A patient is experiencing hypoxia. The nurse would expect to see which of
the following early signs?
A. Cyanosis of the nail beds.
B. Restlessness and confusion.
C. Bradypnea.
D. Decreased blood pressure.
🟢 Correct Answer: B. Restlessness and confusion.
🔴 Explanation: The central nervous system is highly sensitive to oxygen
deprivation. Early signs of hypoxia include restlessness, confusion, and anxiety.
Cyanosis is a late sign. Tachypnea (not bradypnea) is an early compensatory
response, and blood pressure may initially increase.
