NSG 100 Exam 2 | (2026) Nursing Concepts
Questions | Fundamentals Review (PDF)
1. A nurse is implementing fall precautions for an older
adult patient. Which action is most appropriate?
A. Keep all four side rails up at night.
B. Place the bed in the lowest position with locked wheels.
C. Encourage the patient to wear non-skid socks only
during the day.
D. Keep the call light on the bedside table.
Answer: B
Rationale: The bed should be in the lowest position and
wheels locked to reduce injury from falls. Side rails up (A)
is a restraint. Non-skid socks should be worn anytime the
patient is out of bed. Call light must be within easy reach
(attached to gown or pillow).
2. Which patient is at the highest risk for falling?
A. 45-year-old post-operative day 1.
B. 70-year-old with history of stroke and taking
1
,antihypertensives.
C. 30-year-old with a broken ankle using crutches.
D. 80-year-old with mild hearing loss.
Answer: B
Rationale: The 70-year-old has multiple risk factors: age,
history of stroke (hemiparesis/neglect), and
antihypertensive meds (orthostatic hypotension). Hearing
loss alone (D) is lower risk.
3. A patient uses a cane. The nurse should instruct the
patient to hold the cane on which side?
A. The weaker side.
B. The stronger side.
C. The side with most pain.
D. The contralateral side to the affected leg.
Answer: B / D (Both B and D correct – stronger side
contralateral to weak leg)
Rationale: The cane is held on the stronger side to
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,distribute weight away from the weaker lower extremity.
Cane moves with the weaker leg.
4. When transferring a patient from bed to chair using a
transfer belt, the nurse should:
A. Position the chair at a 90-degree angle to the bed.
B. Keep feet together to maintain a stable base.
C. Stand with feet shoulder-width apart, knees flexed.
D. Lift the patient by holding under the axillae.
Answer: C
Rationale: Wide base of support and flexed knees
protect the nurse’s back. Chair should be at 45° angle,
not 90°. Axillary pressure can injure brachial plexus
nerves.
5. A patient is on contact precautions. Which personal
protective equipment (PPE) is required upon entering the
room?
A. N95 respirator and gloves.
B. Gown and gloves.
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, C. Mask, gown, and gloves.
D. Gloves only.
Answer: B
Rationale: Contact precautions require gown and gloves.
Mask (C) is for droplet/airborne. N95 (A) is for airborne
(TB, measles).
6. The nurse is applying a restraint. Which action
indicates a need for further teaching?
A. Tying the restraint to the bed frame using a quick-
release knot.
B. Checking the patient’s circulation every 30 minutes.
C. Removing the restraint every 2 hours for range of
motion.
D. Using a vest restraint when the patient is supine.
Answer: D
Rationale: Vest restraints should never be used with a
patient lying flat due to strangulation risk. They require
head of bed elevated. A quick-release knot (A) is correct.
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Questions | Fundamentals Review (PDF)
1. A nurse is implementing fall precautions for an older
adult patient. Which action is most appropriate?
A. Keep all four side rails up at night.
B. Place the bed in the lowest position with locked wheels.
C. Encourage the patient to wear non-skid socks only
during the day.
D. Keep the call light on the bedside table.
Answer: B
Rationale: The bed should be in the lowest position and
wheels locked to reduce injury from falls. Side rails up (A)
is a restraint. Non-skid socks should be worn anytime the
patient is out of bed. Call light must be within easy reach
(attached to gown or pillow).
2. Which patient is at the highest risk for falling?
A. 45-year-old post-operative day 1.
B. 70-year-old with history of stroke and taking
1
,antihypertensives.
C. 30-year-old with a broken ankle using crutches.
D. 80-year-old with mild hearing loss.
Answer: B
Rationale: The 70-year-old has multiple risk factors: age,
history of stroke (hemiparesis/neglect), and
antihypertensive meds (orthostatic hypotension). Hearing
loss alone (D) is lower risk.
3. A patient uses a cane. The nurse should instruct the
patient to hold the cane on which side?
A. The weaker side.
B. The stronger side.
C. The side with most pain.
D. The contralateral side to the affected leg.
Answer: B / D (Both B and D correct – stronger side
contralateral to weak leg)
Rationale: The cane is held on the stronger side to
2
,distribute weight away from the weaker lower extremity.
Cane moves with the weaker leg.
4. When transferring a patient from bed to chair using a
transfer belt, the nurse should:
A. Position the chair at a 90-degree angle to the bed.
B. Keep feet together to maintain a stable base.
C. Stand with feet shoulder-width apart, knees flexed.
D. Lift the patient by holding under the axillae.
Answer: C
Rationale: Wide base of support and flexed knees
protect the nurse’s back. Chair should be at 45° angle,
not 90°. Axillary pressure can injure brachial plexus
nerves.
5. A patient is on contact precautions. Which personal
protective equipment (PPE) is required upon entering the
room?
A. N95 respirator and gloves.
B. Gown and gloves.
3
, C. Mask, gown, and gloves.
D. Gloves only.
Answer: B
Rationale: Contact precautions require gown and gloves.
Mask (C) is for droplet/airborne. N95 (A) is for airborne
(TB, measles).
6. The nurse is applying a restraint. Which action
indicates a need for further teaching?
A. Tying the restraint to the bed frame using a quick-
release knot.
B. Checking the patient’s circulation every 30 minutes.
C. Removing the restraint every 2 hours for range of
motion.
D. Using a vest restraint when the patient is supine.
Answer: D
Rationale: Vest restraints should never be used with a
patient lying flat due to strangulation risk. They require
head of bed elevated. A quick-release knot (A) is correct.
4
