NSG 3130 — Fundamentals II
Targeted Underrepresented Topics & NGN-Style Clinical Judgment Case Studies — 70 Questions
Health Literacy · Activity & Exercise · Cognitive/Sensory Alterations · Sleep · Clinical Judgment
Directions: Every item on this test requires interpreting findings, comparing similar clinical presentations, prioritizing nursing actions,
or recognizing subtle differences between disorders — no question can be answered by recalling a single definition. Read each stem
carefully. For standard and EXCEPT items, select the single best answer. For SATA (Select All That Apply) items, select every option
that applies. The answer key with full rationales for every option begins after the questions.
Format legend: Standard best-answer | [SATA] Select All That Apply | [EXCEPT] Identify the exception | [PRIORITY] Triage /
prioritization
HEALTH LITERACY: UNDERREPRESENTED TOPICS — Questions 1–8
Q1. A children's hospital develops a tele-education program after identifying that many families were missing in-person diabetes
education sessions. What barriers does tele-education most directly address?
Telehealth and tele-education
A. Travel time, childcare needs, and costs associated with attending in-person sessions
B. The need for patients to demonstrate a skill, since tele-education eliminates return demonstration completely
C. The requirement for reliable internet access, which tele-education removes completely for all patients
D. The need for any nurse involvement, since tele-education is fully automated with no live component
Q2. A patient is receiving diabetes education from different nurses across several shifts. What is the most important reason for
thorough electronic documentation of each teaching session?
Documentation of patient education across shifts
A. Electronic documentation is required just if the patient specifically requests a written record
B. All teaching team members need accurate, up-to-date information about the patient's progress toward goals
C. Documentation of patient education is optional as long as the patient appears to understand the material
D. Just the first nurse who began the education plan needs to document any part of the session
Q3. A facility uses a multiple-copy form that is signed by both the nurse and the patient whenever teaching occurs. What is the
primary purpose of this type of documentation tool?
Multi-copy teaching documentation forms
A. To replace the need for any further documentation of teaching in the electronic health record
B. To serve exclusively as a billing document with no relevance to continuity of patient care
C. To indicate and confirm that specific teaching has taken place, with a record available to both parties
D. To document just the patient's vital signs at the time teaching occurred, unrelated to content taught
Q4. A patient being discharged home does not have insurance coverage for necessary wound care supplies. What is the most
appropriate nursing action to support continued patient education and self-management at home?
Community teaching resources
A. Withhold all wound care teaching until the patient independently resolves the insurance issue
B. Tell the patient that community resources are rarely available for this type of need
C. Refer the patient exclusively to an online forum with no connection to the health care team
D. Contact social services, discharge planning, or community agencies to identify resources such as fee waivers
,Q5. [SATA] A nurse applies several QSEN (Quality and Safety Education for Nurses) principles when planning patient teaching.
Which actions reflect QSEN-related best practices for patient education? (Select all that apply.)
QSEN principles in patient education
Select all that apply.
■ 1. Evaluating the reliability of health care information sources used for patient teaching
■ 2. Involving patients and families as active partners in patient-centered education
■ 3. Collaborating with the interprofessional team, including therapists and dietitians, when planning teaching
■ 4. Making all teaching decisions independently without any input from the patient
■ 5. Recognizing and integrating the contributions of team members while respecting their unique expertise
Q6. A nurse completes a lengthy diabetes teaching session but does not document any of the content covered in the patient's medical
record. What is the primary legal and ethical concern with this omission?
Legal and ethical responsibility in patient education
A. The medical record should clearly identify education conducted, since this is imperative in today's litigious environment
B. There is no legal or ethical concern, since verbal teaching alone fulfills the nurse's professional responsibility
C. Documentation of patient education is a courtesy rather than an ethical responsibility of the nursing profession
D. The concern applies just to physicians and does not extend to the professional responsibilities of nurses
Q7. A patient is being transferred from the hospital to a long-term care facility partway through a diabetes education plan. What is
most important for ensuring continuity of the patient's education across this transition?
Continuity of education across care settings
A. Restarting the entire education plan from the very beginning at the new facility regardless of prior progress
B. Complete, accurate documentation of the teaching plan and progress so far, made available to the receiving facility's staff
C. Assuming that education needs stop completely once a patient leaves the acute care hospital setting
D. Relying mainly on the patient's own memory of what was taught, without any written documentation
Q8. [PRIORITY] A patient with a documented teaching plan is being discharged to home health care. Which action best supports
continuity of the patient's education plan into the home setting?
Selecting the right technology for continuity
A. Discard the hospital's teaching plan and progress notes, since the home health nurse will start fresh
B. Provide the home health nurse with just a verbal summary and no written documentation of any kind
C. Ensure the teaching plan and progress documentation are readily available to all staff who will visit the home
D. Assume the home health team requires no information about what was already taught in the hospital
ACTIVITY & EXERCISE: UNDERREPRESENTED TOPICS — Questions 9–24
Q9. A nurse is teaching a patient how to structure a new exercise plan using the FITT principle. Which elements should the nurse
address as part of this framework?
FITT principle
A. Frequency, Intensity, Time, and Type of exercise
B. Function, Injury risk, Tolerance, and Technique of exercise
C. Fitness level, Illness history, Treatment goals, and Timing of meals
D. Flexibility, Isolation training, Tempo, and Total repetitions
Q10. A nurse compares two exercises. Exercise A involves a patient tensing and relaxing the quadriceps muscle without moving the
knee joint. Exercise B involves a patient walking down the hallway with continuous muscle contraction and joint movement. Which
types of exercise are these, respectively?
Isometric vs. isotonic exercise
A. Isotonic exercise for Exercise A and isometric exercise for Exercise B
B. Isometric exercise for Exercise A and isotonic exercise for Exercise B
C. Both exercises are the same type, differing just in which muscle group is used
D. Neither exercise matches a recognized category of exercise by muscle status
, Q11. A nurse compares two forms of exercise. Exercise A requires oxygen metabolism to sustain repeated stair climbing over time.
Exercise B, such as heavy weight lifting, builds power and body mass without oxygen being used to produce energy for the activity.
Which types of exercise are these, respectively?
Aerobic vs. anaerobic exercise
A. Anaerobic exercise for Exercise A and aerobic exercise for Exercise B
B. Both exercises rely on the identical energy source and mechanism
C. Aerobic exercise for Exercise A and anaerobic exercise for Exercise B
D. Neither exercise matches a recognized category of exercise by energy source
Q12. [SATA] A nurse is selecting positioning devices to prevent complications in immobile patients. Which of the following are
recognized positioning devices used for this purpose? (Select all that apply.)
Positioning devices overview
Select all that apply.
■ 1. Trochanter roll, used to prevent external rotation of the hip
■ 2. Footboard, used to help prevent footdrop by supporting the foot at a right angle
■ 3. Hand roll, used on a short-term basis to maintain a functional hand position
■ 4. Splints and braces, used to keep joints in functional positions
■ 5. Stethoscope, used specifically as a positioning device for bedbound patients
Q13. A nurse needs to prevent external hip rotation in a supine patient after hip surgery but does not have a manufactured trochanter
roll available. What is an appropriate alternative, and where is it placed?
Trochanter roll technique
A. A rolled blanket can rarely substitute for a manufactured trochanter roll under any circumstances
B. The substitute device should be placed under the patient's shoulders rather than near the hip
C. No alternative device exists, and positioning must be delayed until a manufactured roll arrives
D. A rolled blanket or sandbag can substitute for a trochanter roll and should be placed alongside the patient's hip
Q14. A patient with equal bilateral upper extremity strength has a trapeze bar attached to the bed frame. What is the primary purpose
of this device, and what additional benefit does its use provide?
Trapeze bar use
A. The patient grabs the bar to assist repositioning and transferring, decreasing shear risk and building strength
B. The trapeze bar is used exclusively to measure the patient's grip strength for documentation purposes
C. The trapeze bar is intended just for patients with lower extremity paralysis and no upper body involvement
D. The trapeze bar eliminates any need for the patient to participate in their own repositioning or transfers
Q15. A nurse encourages a postoperative patient to use an incentive spirometer regularly. What is the primary purpose of this
intervention?
Incentive spirometry
A. To measure the patient's blood pressure response to activity as an alternative to a manual cuff
B. To aid lung expansion and decrease the chance of pulmonary secretions pooling in dependent lung areas
C. To directly strengthen the muscles of the lower extremities in an immobile patient
D. To replace the need for turning and repositioning an immobile patient completely
Q16. A nurse teaches a postoperative patient to perform routine coughing and deep-breathing exercises. What is the primary
rationale for this intervention in an immobile patient?
Deep breathing and coughing exercises
A. These exercises are performed mainly to help the patient pass time during a long hospital stay
B. These exercises are intended to replace the need for any pharmacologic pain management
C. These exercises aid lung expansion and help prevent pooling of secretions that can lead to pneumonia
D. These exercises primarily strengthen the muscles of the upper extremities rather than the lungs
Targeted Underrepresented Topics & NGN-Style Clinical Judgment Case Studies — 70 Questions
Health Literacy · Activity & Exercise · Cognitive/Sensory Alterations · Sleep · Clinical Judgment
Directions: Every item on this test requires interpreting findings, comparing similar clinical presentations, prioritizing nursing actions,
or recognizing subtle differences between disorders — no question can be answered by recalling a single definition. Read each stem
carefully. For standard and EXCEPT items, select the single best answer. For SATA (Select All That Apply) items, select every option
that applies. The answer key with full rationales for every option begins after the questions.
Format legend: Standard best-answer | [SATA] Select All That Apply | [EXCEPT] Identify the exception | [PRIORITY] Triage /
prioritization
HEALTH LITERACY: UNDERREPRESENTED TOPICS — Questions 1–8
Q1. A children's hospital develops a tele-education program after identifying that many families were missing in-person diabetes
education sessions. What barriers does tele-education most directly address?
Telehealth and tele-education
A. Travel time, childcare needs, and costs associated with attending in-person sessions
B. The need for patients to demonstrate a skill, since tele-education eliminates return demonstration completely
C. The requirement for reliable internet access, which tele-education removes completely for all patients
D. The need for any nurse involvement, since tele-education is fully automated with no live component
Q2. A patient is receiving diabetes education from different nurses across several shifts. What is the most important reason for
thorough electronic documentation of each teaching session?
Documentation of patient education across shifts
A. Electronic documentation is required just if the patient specifically requests a written record
B. All teaching team members need accurate, up-to-date information about the patient's progress toward goals
C. Documentation of patient education is optional as long as the patient appears to understand the material
D. Just the first nurse who began the education plan needs to document any part of the session
Q3. A facility uses a multiple-copy form that is signed by both the nurse and the patient whenever teaching occurs. What is the
primary purpose of this type of documentation tool?
Multi-copy teaching documentation forms
A. To replace the need for any further documentation of teaching in the electronic health record
B. To serve exclusively as a billing document with no relevance to continuity of patient care
C. To indicate and confirm that specific teaching has taken place, with a record available to both parties
D. To document just the patient's vital signs at the time teaching occurred, unrelated to content taught
Q4. A patient being discharged home does not have insurance coverage for necessary wound care supplies. What is the most
appropriate nursing action to support continued patient education and self-management at home?
Community teaching resources
A. Withhold all wound care teaching until the patient independently resolves the insurance issue
B. Tell the patient that community resources are rarely available for this type of need
C. Refer the patient exclusively to an online forum with no connection to the health care team
D. Contact social services, discharge planning, or community agencies to identify resources such as fee waivers
,Q5. [SATA] A nurse applies several QSEN (Quality and Safety Education for Nurses) principles when planning patient teaching.
Which actions reflect QSEN-related best practices for patient education? (Select all that apply.)
QSEN principles in patient education
Select all that apply.
■ 1. Evaluating the reliability of health care information sources used for patient teaching
■ 2. Involving patients and families as active partners in patient-centered education
■ 3. Collaborating with the interprofessional team, including therapists and dietitians, when planning teaching
■ 4. Making all teaching decisions independently without any input from the patient
■ 5. Recognizing and integrating the contributions of team members while respecting their unique expertise
Q6. A nurse completes a lengthy diabetes teaching session but does not document any of the content covered in the patient's medical
record. What is the primary legal and ethical concern with this omission?
Legal and ethical responsibility in patient education
A. The medical record should clearly identify education conducted, since this is imperative in today's litigious environment
B. There is no legal or ethical concern, since verbal teaching alone fulfills the nurse's professional responsibility
C. Documentation of patient education is a courtesy rather than an ethical responsibility of the nursing profession
D. The concern applies just to physicians and does not extend to the professional responsibilities of nurses
Q7. A patient is being transferred from the hospital to a long-term care facility partway through a diabetes education plan. What is
most important for ensuring continuity of the patient's education across this transition?
Continuity of education across care settings
A. Restarting the entire education plan from the very beginning at the new facility regardless of prior progress
B. Complete, accurate documentation of the teaching plan and progress so far, made available to the receiving facility's staff
C. Assuming that education needs stop completely once a patient leaves the acute care hospital setting
D. Relying mainly on the patient's own memory of what was taught, without any written documentation
Q8. [PRIORITY] A patient with a documented teaching plan is being discharged to home health care. Which action best supports
continuity of the patient's education plan into the home setting?
Selecting the right technology for continuity
A. Discard the hospital's teaching plan and progress notes, since the home health nurse will start fresh
B. Provide the home health nurse with just a verbal summary and no written documentation of any kind
C. Ensure the teaching plan and progress documentation are readily available to all staff who will visit the home
D. Assume the home health team requires no information about what was already taught in the hospital
ACTIVITY & EXERCISE: UNDERREPRESENTED TOPICS — Questions 9–24
Q9. A nurse is teaching a patient how to structure a new exercise plan using the FITT principle. Which elements should the nurse
address as part of this framework?
FITT principle
A. Frequency, Intensity, Time, and Type of exercise
B. Function, Injury risk, Tolerance, and Technique of exercise
C. Fitness level, Illness history, Treatment goals, and Timing of meals
D. Flexibility, Isolation training, Tempo, and Total repetitions
Q10. A nurse compares two exercises. Exercise A involves a patient tensing and relaxing the quadriceps muscle without moving the
knee joint. Exercise B involves a patient walking down the hallway with continuous muscle contraction and joint movement. Which
types of exercise are these, respectively?
Isometric vs. isotonic exercise
A. Isotonic exercise for Exercise A and isometric exercise for Exercise B
B. Isometric exercise for Exercise A and isotonic exercise for Exercise B
C. Both exercises are the same type, differing just in which muscle group is used
D. Neither exercise matches a recognized category of exercise by muscle status
, Q11. A nurse compares two forms of exercise. Exercise A requires oxygen metabolism to sustain repeated stair climbing over time.
Exercise B, such as heavy weight lifting, builds power and body mass without oxygen being used to produce energy for the activity.
Which types of exercise are these, respectively?
Aerobic vs. anaerobic exercise
A. Anaerobic exercise for Exercise A and aerobic exercise for Exercise B
B. Both exercises rely on the identical energy source and mechanism
C. Aerobic exercise for Exercise A and anaerobic exercise for Exercise B
D. Neither exercise matches a recognized category of exercise by energy source
Q12. [SATA] A nurse is selecting positioning devices to prevent complications in immobile patients. Which of the following are
recognized positioning devices used for this purpose? (Select all that apply.)
Positioning devices overview
Select all that apply.
■ 1. Trochanter roll, used to prevent external rotation of the hip
■ 2. Footboard, used to help prevent footdrop by supporting the foot at a right angle
■ 3. Hand roll, used on a short-term basis to maintain a functional hand position
■ 4. Splints and braces, used to keep joints in functional positions
■ 5. Stethoscope, used specifically as a positioning device for bedbound patients
Q13. A nurse needs to prevent external hip rotation in a supine patient after hip surgery but does not have a manufactured trochanter
roll available. What is an appropriate alternative, and where is it placed?
Trochanter roll technique
A. A rolled blanket can rarely substitute for a manufactured trochanter roll under any circumstances
B. The substitute device should be placed under the patient's shoulders rather than near the hip
C. No alternative device exists, and positioning must be delayed until a manufactured roll arrives
D. A rolled blanket or sandbag can substitute for a trochanter roll and should be placed alongside the patient's hip
Q14. A patient with equal bilateral upper extremity strength has a trapeze bar attached to the bed frame. What is the primary purpose
of this device, and what additional benefit does its use provide?
Trapeze bar use
A. The patient grabs the bar to assist repositioning and transferring, decreasing shear risk and building strength
B. The trapeze bar is used exclusively to measure the patient's grip strength for documentation purposes
C. The trapeze bar is intended just for patients with lower extremity paralysis and no upper body involvement
D. The trapeze bar eliminates any need for the patient to participate in their own repositioning or transfers
Q15. A nurse encourages a postoperative patient to use an incentive spirometer regularly. What is the primary purpose of this
intervention?
Incentive spirometry
A. To measure the patient's blood pressure response to activity as an alternative to a manual cuff
B. To aid lung expansion and decrease the chance of pulmonary secretions pooling in dependent lung areas
C. To directly strengthen the muscles of the lower extremities in an immobile patient
D. To replace the need for turning and repositioning an immobile patient completely
Q16. A nurse teaches a postoperative patient to perform routine coughing and deep-breathing exercises. What is the primary
rationale for this intervention in an immobile patient?
Deep breathing and coughing exercises
A. These exercises are performed mainly to help the patient pass time during a long hospital stay
B. These exercises are intended to replace the need for any pharmacologic pain management
C. These exercises aid lung expansion and help prevent pooling of secretions that can lead to pneumonia
D. These exercises primarily strengthen the muscles of the upper extremities rather than the lungs
