BSN 346 | BSN346 Exam 3: Concepts of Nursing III
Updated and Latest Questions and Correct
Answers with Rationale - Nightingale College
1. A 72-year-old patient with heart failure and type 2 diabetes is being prepared for
discharge. Which interdisciplinary team member is most critical to involve to ensure the
patient understands their new dietary restrictions and insulin management?
A. Occupational Therapist
B. Physical Therapist
C. Registered Dietitian
D. Social Worker
Correct Answer: C
Expert Explanation: The Registered Dietitian provides specialized knowledge on
managing complex nutritional needs for patients with multiple comorbidities. They are
uniquely qualified to create a meal plan that balances low sodium for heart failure and
glycemic control for diabetes. Involving them early in discharge planning helps prevent
readmission related to metabolic or fluid instability. While social workers assist with
resources, they do not provide clinical dietary education. This collaborative approach
ensures the patient receives evidence-based instruction tailored to their specific health
conditions.
2. A nurse is coordinating care for a patient with a new diagnosis of Stage III chronic kidney
disease (CKD) and hypertension. Which action by the nurse best demonstrates effective care
coordination?
A. Scheduling the patient for a follow-up appointment with a nephrologist within two
weeks.
B. Instructing the patient to increase protein intake to promote tissue healing.
C. Suggesting the patient use over-the-counter NSAIDs for joint pain.
D. Waiting for the physician to decide when the patient should return to the clinic.
Correct Answer: A
Expert Explanation: Coordinating timely follow-up care with specialists is a core
component of effective nursing management for chronic diseases. Stage III CKD requires
careful monitoring by a nephrologist to slow disease progression and manage blood
pressure. High protein intake is generally restricted in CKD to reduce the workload on the
kidneys, making that option incorrect. NSAIDs are nephrotoxic and should be avoided in
patients with renal impairment. Proactive scheduling ensures the continuity of care and
prevents gaps in treatment that lead to complications.
,3. When evaluating the outcomes of a patient-centered education plan for a patient using an
incentive spirometer, which method provides the best evidence of learning?
A. The patient states they understand how to use the device.
B. The patient performs a return demonstration of the correct technique.
C. The patient reads the educational brochure provided by the nurse.
D. The family members confirm they watched the patient use it correctly.
Correct Answer: B
Expert Explanation: The ‘teach-back’ or return demonstration method is the gold
standard for evaluating psychomotor learning in clinical practice. It allows the nurse to
directly observe the patient’s technique and correct any errors in real-time. Verbal
statements of understanding are often unreliable due to the patient’s desire to please the
healthcare provider. Written materials are helpful supplements but do not confirm physical
competency with medical equipment. Direct observation ensures the patient can effectively
perform the intervention to prevent postoperative complications like pneumonia.
4. A patient with COPD and chronic stable angina is being discharged. The nurse is performing
medication reconciliation. Which medication should the nurse prioritize for patient education
regarding potential interactions?
A. Propranolol (Inderal)
B. Albuterol (Proventil)
C. Lisinopril (Zestril)
D. Simvastatin (Zocor)
Correct Answer: A
Expert Explanation: Propranolol is a non-selective beta-blocker that can cause
bronchoconstriction, which is dangerous for patients with COPD. It antagonizes the effects
of bronchodilators like Albuterol, potentially leading to a severe respiratory crisis. Selective
beta-blockers are preferred if heart disease management is necessary for a patient with
underlying lung disease. The nurse must identify this contraindication during medication
reconciliation to prevent adverse outcomes. Educating the patient on why specific
medications are chosen over others promotes safety and medication adherence.
5. During a multidisciplinary team meeting, the nurse reports that a patient with a hip
fracture is refusing to work with the physical therapist due to fear of falling. What is the
nurse’s primary role in this scenario?
A. To document the refusal and wait for the patient to change their mind.
B. To insist the patient participate to meet discharge goals.
, C. To advocate for the patient by exploring the underlying cause of the fear and
communicating it to the team.
D. To ask the physician to prescribe anti-anxiety medication so therapy can proceed.
Correct Answer: C
Expert Explanation: The nurse serves as the primary advocate for the patient within the
interdisciplinary team by identifying barriers to recovery. Exploring the fear of falling
allows the team to adjust the care plan, perhaps by involving a psychologist or using
different assistive devices. Simply documenting refusal without intervention delays
rehabilitation and increases the risk of complications from immobility. Forcing
participation violates patient autonomy and may damage the therapeutic relationship.
Effective advocacy leads to personalized care that addresses both physical and
psychological needs.
6. A patient with multiple comorbidities including morbid obesity, venous stasis, and
peripheral vascular disease is at high risk for skin breakdown. Which interdisciplinary
intervention is most appropriate?
A. Ordering a high-protein diet without consulting the dietitian.
B. Applying antibiotic ointment to all reddened areas daily.
C. Limiting the patient’s movement to prevent friction and shearing.
D. Consulting a Wound, Ostomy, and Continence Nurse (WOCN) for a preventive skin care
protocol.
Correct Answer: D
Expert Explanation: Wound, Ostomy, and Continence Nurses are specialists who provide
evidence-based strategies for preventing and managing skin integrity issues. Their
expertise is vital when dealing with patients whose comorbidities significantly increase the
risk of pressure ulcers. Limiting movement is counterproductive, as frequent repositioning
is a key preventive measure. Standardizing a care protocol with a specialist ensures all
team members are following the most effective interventions. Proactive management
reduces hospital-acquired injuries and improves long-term patient outcomes.
7. The nurse is preparing a discharge plan for a homeless patient with a newly diagnosed
heart condition. Which factor is most important to assess to ensure compliance with the
medical regimen?
A. The patient’s level of education.
B. The distance from the hospital to the patient’s previous shelter.
C. The patient’s preference for generic vs. brand name drugs.
D. The availability of community resources and social support.
Correct Answer: D
Updated and Latest Questions and Correct
Answers with Rationale - Nightingale College
1. A 72-year-old patient with heart failure and type 2 diabetes is being prepared for
discharge. Which interdisciplinary team member is most critical to involve to ensure the
patient understands their new dietary restrictions and insulin management?
A. Occupational Therapist
B. Physical Therapist
C. Registered Dietitian
D. Social Worker
Correct Answer: C
Expert Explanation: The Registered Dietitian provides specialized knowledge on
managing complex nutritional needs for patients with multiple comorbidities. They are
uniquely qualified to create a meal plan that balances low sodium for heart failure and
glycemic control for diabetes. Involving them early in discharge planning helps prevent
readmission related to metabolic or fluid instability. While social workers assist with
resources, they do not provide clinical dietary education. This collaborative approach
ensures the patient receives evidence-based instruction tailored to their specific health
conditions.
2. A nurse is coordinating care for a patient with a new diagnosis of Stage III chronic kidney
disease (CKD) and hypertension. Which action by the nurse best demonstrates effective care
coordination?
A. Scheduling the patient for a follow-up appointment with a nephrologist within two
weeks.
B. Instructing the patient to increase protein intake to promote tissue healing.
C. Suggesting the patient use over-the-counter NSAIDs for joint pain.
D. Waiting for the physician to decide when the patient should return to the clinic.
Correct Answer: A
Expert Explanation: Coordinating timely follow-up care with specialists is a core
component of effective nursing management for chronic diseases. Stage III CKD requires
careful monitoring by a nephrologist to slow disease progression and manage blood
pressure. High protein intake is generally restricted in CKD to reduce the workload on the
kidneys, making that option incorrect. NSAIDs are nephrotoxic and should be avoided in
patients with renal impairment. Proactive scheduling ensures the continuity of care and
prevents gaps in treatment that lead to complications.
,3. When evaluating the outcomes of a patient-centered education plan for a patient using an
incentive spirometer, which method provides the best evidence of learning?
A. The patient states they understand how to use the device.
B. The patient performs a return demonstration of the correct technique.
C. The patient reads the educational brochure provided by the nurse.
D. The family members confirm they watched the patient use it correctly.
Correct Answer: B
Expert Explanation: The ‘teach-back’ or return demonstration method is the gold
standard for evaluating psychomotor learning in clinical practice. It allows the nurse to
directly observe the patient’s technique and correct any errors in real-time. Verbal
statements of understanding are often unreliable due to the patient’s desire to please the
healthcare provider. Written materials are helpful supplements but do not confirm physical
competency with medical equipment. Direct observation ensures the patient can effectively
perform the intervention to prevent postoperative complications like pneumonia.
4. A patient with COPD and chronic stable angina is being discharged. The nurse is performing
medication reconciliation. Which medication should the nurse prioritize for patient education
regarding potential interactions?
A. Propranolol (Inderal)
B. Albuterol (Proventil)
C. Lisinopril (Zestril)
D. Simvastatin (Zocor)
Correct Answer: A
Expert Explanation: Propranolol is a non-selective beta-blocker that can cause
bronchoconstriction, which is dangerous for patients with COPD. It antagonizes the effects
of bronchodilators like Albuterol, potentially leading to a severe respiratory crisis. Selective
beta-blockers are preferred if heart disease management is necessary for a patient with
underlying lung disease. The nurse must identify this contraindication during medication
reconciliation to prevent adverse outcomes. Educating the patient on why specific
medications are chosen over others promotes safety and medication adherence.
5. During a multidisciplinary team meeting, the nurse reports that a patient with a hip
fracture is refusing to work with the physical therapist due to fear of falling. What is the
nurse’s primary role in this scenario?
A. To document the refusal and wait for the patient to change their mind.
B. To insist the patient participate to meet discharge goals.
, C. To advocate for the patient by exploring the underlying cause of the fear and
communicating it to the team.
D. To ask the physician to prescribe anti-anxiety medication so therapy can proceed.
Correct Answer: C
Expert Explanation: The nurse serves as the primary advocate for the patient within the
interdisciplinary team by identifying barriers to recovery. Exploring the fear of falling
allows the team to adjust the care plan, perhaps by involving a psychologist or using
different assistive devices. Simply documenting refusal without intervention delays
rehabilitation and increases the risk of complications from immobility. Forcing
participation violates patient autonomy and may damage the therapeutic relationship.
Effective advocacy leads to personalized care that addresses both physical and
psychological needs.
6. A patient with multiple comorbidities including morbid obesity, venous stasis, and
peripheral vascular disease is at high risk for skin breakdown. Which interdisciplinary
intervention is most appropriate?
A. Ordering a high-protein diet without consulting the dietitian.
B. Applying antibiotic ointment to all reddened areas daily.
C. Limiting the patient’s movement to prevent friction and shearing.
D. Consulting a Wound, Ostomy, and Continence Nurse (WOCN) for a preventive skin care
protocol.
Correct Answer: D
Expert Explanation: Wound, Ostomy, and Continence Nurses are specialists who provide
evidence-based strategies for preventing and managing skin integrity issues. Their
expertise is vital when dealing with patients whose comorbidities significantly increase the
risk of pressure ulcers. Limiting movement is counterproductive, as frequent repositioning
is a key preventive measure. Standardizing a care protocol with a specialist ensures all
team members are following the most effective interventions. Proactive management
reduces hospital-acquired injuries and improves long-term patient outcomes.
7. The nurse is preparing a discharge plan for a homeless patient with a newly diagnosed
heart condition. Which factor is most important to assess to ensure compliance with the
medical regimen?
A. The patient’s level of education.
B. The distance from the hospital to the patient’s previous shelter.
C. The patient’s preference for generic vs. brand name drugs.
D. The availability of community resources and social support.
Correct Answer: D
