NR224 Fundamentals of Nursing
Exam 2: Mastery Assessment | 2026/2027 Academic Year | Chamberlain
University
Time Allowed: 120 minutes
Passing Score: 92% (55/60 correct)
Total Questions: 60 (including 8 NGN-style questions)
EXAMINATION INSTRUCTIONS
Select the best answer for each question. For Next Generation NCLEX (NGN) questions,
follow the specific instructions provided. Some questions may require selection of
multiple correct answers or sequencing of responses. Calculators are permitted for
dosage calculation questions.
DOMAIN I: ACTIVITY, MOBILITY & SAFETY (Questions 1-15)
Q1. [Recall - Body Mechanics]
A nurse educator is observing a nursing student transfer a patient from bed to
wheelchair. Which action by the student requires immediate correction?
A. The student positions the wheelchair at a 45-degree angle to the bed
B. The student bends at the waist to lift the patient under the arms
C. The student locks the wheelchair brakes before beginning the transfer [CORRECT]
D. The student counts to three with the patient before standing
Correct Answer: C
Rationale: The wheelchair brakes must be locked to prevent movement during
transfer—this is correct practice. However, bending at the waist (Option B) violates
fundamental body mechanics principles and places the nurse at risk for musculoskeletal
injury. Proper technique requires bending at the knees, keeping the back straight, and
using leg muscles (Potter & Perry, Chapter 30). Option A demonstrates proper
positioning for pivot transfers, and Option C is actually correct practice. Option D
promotes patient cooperation and safety.
,Distractor Analysis: Option B represents a common novice error—using back muscles
instead of leg muscles. Novice nurses often rush transfers and forget proper body
mechanics when fatigued.
Nursing Consideration: Always perform a mobility assessment before any transfer;
never lift patients alone when they exceed safe weight limits—use mechanical lift
devices per facility protocol.
Q2. [Application - Fall Prevention]
An 82-year-old patient with Parkinson's disease, history of orthostatic hypotension, and
new prescription for metoprolol is admitted for pneumonia. Which nursing intervention
is the highest priority for fall prevention?
A. Placing the call light within reach and educating on its use
B. Implementing a scheduled toileting program every 2 hours
C. Assisting with all ambulation and using a gait belt [CORRECT]
D. Ensuring adequate lighting and removing clutter from the room
Correct Answer: C
Rationale: While all options are valid fall prevention strategies, assisting with
ambulation and using a gait belt (Option C) addresses the patient's specific high-risk
factors: Parkinson's disease (impaired gait/balance), orthostatic hypotension (risk for
syncope), and beta-blocker side effects (dizziness, bradycardia). This intervention
provides physical support during the highest-risk activity. The Morse Fall Scale would
likely score this patient as high risk (>50) (Potter & Perry, Chapter 30; CDC STEADI
Algorithm).
Distractor Analysis: Options A, B, and D are standard fall precautions but do not
address the immediate physical instability caused by this patient's combined conditions.
Novice nurses may select environmental modifications (D) without recognizing that
intrinsic factors outweigh extrinsic ones in this scenario.
Nursing Consideration: For patients with orthostatic hypotension, always implement
the "dangle first" protocol—have the patient sit on the edge of the bed for 2-3 minutes
before standing to assess for dizziness.
,Q3. [Analysis - Complications of Immobility]
A 68-year-old postoperative patient has been on bed rest for 5 days following
abdominal surgery. The nurse notes decreased breath sounds in bilateral lower lobes,
temperature 38.1°C (100.6°F), and the patient reports feeling "anxious." Which
complication of immobility is most likely developing?
A. Deep vein thrombosis
B. Atelectasis progressing to pneumonia [CORRECT]
C. Pressure injury formation
D. Urinary tract infection
Correct Answer: B
Rationale: The clinical presentation—decreased breath sounds in dependent lobes, low-
grade fever, and anxiety (early sign of hypoxia)—is classic for atelectasis with early
pneumonia. Immobility causes decreased respiratory excursion, stasis of secretions in
dependent lung regions, and impaired cough mechanism. The 5-day timeline aligns with
hospital-acquired pneumonia development (Potter & Perry, Chapter 30; CDC HAI
guidelines).
Distractor Analysis: DVT (A) would present with unilateral calf pain, warmth, and
swelling. Pressure injury (C) would show localized skin changes. UTI (D) would present
with urinary symptoms, costovertebral angle tenderness, or altered mental status in
older adults.
Nursing Consideration: Implement aggressive pulmonary hygiene: incentive spirometry
10 times hourly while awake, early ambulation, and frequent repositioning. Monitor
SpO2 closely; values <92% require immediate provider notification.
Q4. [Application - Range of Motion]
When performing passive range of motion (PROM) exercises for a patient with left-sided
hemiplegia, the nurse moves the shoulder through flexion, extension, abduction,
adduction, internal rotation, and external rotation. Which movement is missing from
this assessment?
A. Circumduction [CORRECT]
B. Supination
, C. Eversion
D. Protraction
Correct Answer: A
Rationale: The shoulder is a ball-and-socket joint with six movements: flexion,
extension, abduction, adduction, internal rotation, external rotation, and circumduction
(circular movement combining all planes). Circumduction is essential for functional
activities like combing hair or reaching behind the back. Supination (B) and eversion (C)
are movements of the forearm and foot, respectively. Protraction (D) involves scapular
movement, not glenohumeral joint movement (Potter & Perry, Chapter 30).
Distractor Analysis: Novice nurses often confuse joint movements or forget
circumduction because it is less commonly performed in isolation. Understanding joint
anatomy is essential for complete PROM assessments.
Nursing Consideration: Always support the joint above and below during PROM, move
each joint to the point of resistance (not pain), and perform movements 5-10 times, 2-3
times daily for immobilized patients.
Q5. [Analysis - Assistive Devices]
A patient with right-sided weakness following a stroke is being discharged home. The
physical therapist recommends a quad cane. Which assessment finding would
contraindicate the use of this device?
A. The patient weighs 250 lbs and the cane is rated for 300 lbs
B. The patient has severe arthritis in both hands with poor grip strength [CORRECT]
C. The patient lives in a single-story home with carpeted floors
D. The patient demonstrates understanding of "up with the good, down with the bad"
Correct Answer: B
Rationale: Quad canes require adequate hand grip strength and wrist stability to
maintain the cane's position and bear weight through the hand. Severe bilateral hand
arthritis with poor grip would make it impossible to safely use any hand-held assistive
device; a platform walker or wheelchair would be more appropriate (Potter & Perry,
Chapter 30; AHA/ASA Stroke Guidelines).
Distractor Analysis: Option A shows appropriate weight capacity. Option C describes a
safe home environment for cane use. Option D demonstrates correct learning of stair
Exam 2: Mastery Assessment | 2026/2027 Academic Year | Chamberlain
University
Time Allowed: 120 minutes
Passing Score: 92% (55/60 correct)
Total Questions: 60 (including 8 NGN-style questions)
EXAMINATION INSTRUCTIONS
Select the best answer for each question. For Next Generation NCLEX (NGN) questions,
follow the specific instructions provided. Some questions may require selection of
multiple correct answers or sequencing of responses. Calculators are permitted for
dosage calculation questions.
DOMAIN I: ACTIVITY, MOBILITY & SAFETY (Questions 1-15)
Q1. [Recall - Body Mechanics]
A nurse educator is observing a nursing student transfer a patient from bed to
wheelchair. Which action by the student requires immediate correction?
A. The student positions the wheelchair at a 45-degree angle to the bed
B. The student bends at the waist to lift the patient under the arms
C. The student locks the wheelchair brakes before beginning the transfer [CORRECT]
D. The student counts to three with the patient before standing
Correct Answer: C
Rationale: The wheelchair brakes must be locked to prevent movement during
transfer—this is correct practice. However, bending at the waist (Option B) violates
fundamental body mechanics principles and places the nurse at risk for musculoskeletal
injury. Proper technique requires bending at the knees, keeping the back straight, and
using leg muscles (Potter & Perry, Chapter 30). Option A demonstrates proper
positioning for pivot transfers, and Option C is actually correct practice. Option D
promotes patient cooperation and safety.
,Distractor Analysis: Option B represents a common novice error—using back muscles
instead of leg muscles. Novice nurses often rush transfers and forget proper body
mechanics when fatigued.
Nursing Consideration: Always perform a mobility assessment before any transfer;
never lift patients alone when they exceed safe weight limits—use mechanical lift
devices per facility protocol.
Q2. [Application - Fall Prevention]
An 82-year-old patient with Parkinson's disease, history of orthostatic hypotension, and
new prescription for metoprolol is admitted for pneumonia. Which nursing intervention
is the highest priority for fall prevention?
A. Placing the call light within reach and educating on its use
B. Implementing a scheduled toileting program every 2 hours
C. Assisting with all ambulation and using a gait belt [CORRECT]
D. Ensuring adequate lighting and removing clutter from the room
Correct Answer: C
Rationale: While all options are valid fall prevention strategies, assisting with
ambulation and using a gait belt (Option C) addresses the patient's specific high-risk
factors: Parkinson's disease (impaired gait/balance), orthostatic hypotension (risk for
syncope), and beta-blocker side effects (dizziness, bradycardia). This intervention
provides physical support during the highest-risk activity. The Morse Fall Scale would
likely score this patient as high risk (>50) (Potter & Perry, Chapter 30; CDC STEADI
Algorithm).
Distractor Analysis: Options A, B, and D are standard fall precautions but do not
address the immediate physical instability caused by this patient's combined conditions.
Novice nurses may select environmental modifications (D) without recognizing that
intrinsic factors outweigh extrinsic ones in this scenario.
Nursing Consideration: For patients with orthostatic hypotension, always implement
the "dangle first" protocol—have the patient sit on the edge of the bed for 2-3 minutes
before standing to assess for dizziness.
,Q3. [Analysis - Complications of Immobility]
A 68-year-old postoperative patient has been on bed rest for 5 days following
abdominal surgery. The nurse notes decreased breath sounds in bilateral lower lobes,
temperature 38.1°C (100.6°F), and the patient reports feeling "anxious." Which
complication of immobility is most likely developing?
A. Deep vein thrombosis
B. Atelectasis progressing to pneumonia [CORRECT]
C. Pressure injury formation
D. Urinary tract infection
Correct Answer: B
Rationale: The clinical presentation—decreased breath sounds in dependent lobes, low-
grade fever, and anxiety (early sign of hypoxia)—is classic for atelectasis with early
pneumonia. Immobility causes decreased respiratory excursion, stasis of secretions in
dependent lung regions, and impaired cough mechanism. The 5-day timeline aligns with
hospital-acquired pneumonia development (Potter & Perry, Chapter 30; CDC HAI
guidelines).
Distractor Analysis: DVT (A) would present with unilateral calf pain, warmth, and
swelling. Pressure injury (C) would show localized skin changes. UTI (D) would present
with urinary symptoms, costovertebral angle tenderness, or altered mental status in
older adults.
Nursing Consideration: Implement aggressive pulmonary hygiene: incentive spirometry
10 times hourly while awake, early ambulation, and frequent repositioning. Monitor
SpO2 closely; values <92% require immediate provider notification.
Q4. [Application - Range of Motion]
When performing passive range of motion (PROM) exercises for a patient with left-sided
hemiplegia, the nurse moves the shoulder through flexion, extension, abduction,
adduction, internal rotation, and external rotation. Which movement is missing from
this assessment?
A. Circumduction [CORRECT]
B. Supination
, C. Eversion
D. Protraction
Correct Answer: A
Rationale: The shoulder is a ball-and-socket joint with six movements: flexion,
extension, abduction, adduction, internal rotation, external rotation, and circumduction
(circular movement combining all planes). Circumduction is essential for functional
activities like combing hair or reaching behind the back. Supination (B) and eversion (C)
are movements of the forearm and foot, respectively. Protraction (D) involves scapular
movement, not glenohumeral joint movement (Potter & Perry, Chapter 30).
Distractor Analysis: Novice nurses often confuse joint movements or forget
circumduction because it is less commonly performed in isolation. Understanding joint
anatomy is essential for complete PROM assessments.
Nursing Consideration: Always support the joint above and below during PROM, move
each joint to the point of resistance (not pain), and perform movements 5-10 times, 2-3
times daily for immobilized patients.
Q5. [Analysis - Assistive Devices]
A patient with right-sided weakness following a stroke is being discharged home. The
physical therapist recommends a quad cane. Which assessment finding would
contraindicate the use of this device?
A. The patient weighs 250 lbs and the cane is rated for 300 lbs
B. The patient has severe arthritis in both hands with poor grip strength [CORRECT]
C. The patient lives in a single-story home with carpeted floors
D. The patient demonstrates understanding of "up with the good, down with the bad"
Correct Answer: B
Rationale: Quad canes require adequate hand grip strength and wrist stability to
maintain the cane's position and bear weight through the hand. Severe bilateral hand
arthritis with poor grip would make it impossible to safely use any hand-held assistive
device; a platform walker or wheelchair would be more appropriate (Potter & Perry,
Chapter 30; AHA/ASA Stroke Guidelines).
Distractor Analysis: Option A shows appropriate weight capacity. Option C describes a
safe home environment for cane use. Option D demonstrates correct learning of stair
