{"version":"1.0.1","status":"draft_needs_clinical_review","subjects":[{"id":"management-of-care","title":"Management of Care","lessonIds":["w1-task","w1-handoff"],"upcomingTopics":["Prioritizing care","Delegation and supervision","Consent and care coordination"],"testPlanRange":[15,21],"testPlanWeight":18},{"id":"safety-and-infection-prevention-and-control","title":"Safety and Infection Prevention and Control","lessonIds":["w1-safety"],"upcomingTopics":["Infection precautions","Safe equipment use","Preventing injury"],"testPlanRange":[10,16],"testPlanWeight":13},{"id":"health-promotion-and-maintenance","title":"Health Promotion and Maintenance","lessonIds":["w1-teachback"],"upcomingTopics":["Health screening","Growth and development","Pregnancy and newborn care"],"testPlanRange":[6,12],"testPlanWeight":9},{"id":"psychosocial-integrity","title":"Psychosocial Integrity","lessonIds":[],"upcomingTopics":["Therapeutic communication","Mental health care","Crisis support"],"testPlanRange":[6,12],"testPlanWeight":9},{"id":"basic-care-and-comfort","title":"Basic Care and Comfort","lessonIds":["w1-chart"],"upcomingTopics":["Mobility and comfort","Nutrition and elimination","Rest and personal care"],"testPlanRange":[6,12],"testPlanWeight":9},{"id":"pharmacological-and-parenteral-therapies","title":"Pharmacological and Parenteral Therapies","lessonIds":[],"upcomingTopics":["Medication safety","Medication effects","IV therapy"],"testPlanRange":[13,19],"testPlanWeight":16},{"id":"reduction-of-risk-potential","title":"Reduction of Risk Potential","lessonIds":["w1-units","w1-case"],"upcomingTopics":["Laboratory and diagnostic findings","Complication prevention","Responding to changes"],"testPlanRange":[9,15],"testPlanWeight":12},{"id":"physiological-adaptation","title":"Physiological Adaptation","lessonIds":["w1-fluid"],"upcomingTopics":["Acute illness","Body-system changes","Emergency care"],"testPlanRange":[11,17],"testPlanWeight":14}],"placement":{"version":"placement-1","status":"draft_needs_clinical_review","purpose":"Provisional placement out of a specific beginner lesson; not validated mastery or exam readiness.","policy":{"itemsPerSkill":3,"requiredCorrect":3,"noGuesses":true,"oneAttemptPerVersion":true,"delayedReviewDays":1},"items":[{"id":"placement-w1-task-1","familyId":"placement-w1-task-task-first","lessonId":"w1-task","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"A question asks which information the nurse should collect before deciding what to do. What kind of answer is needed?","options":[{"id":"A","text":"An assessment to obtain missing information","rationale":"The task is to gather information before making a decision."},{"id":"B","text":"The treatment to begin immediately","rationale":"Beginning treatment answers an action question instead."},{"id":"C","text":"The final diagnosis","rationale":"The question has not asked for a diagnosis."},{"id":"D","text":"An explanation of why the treatment worked","rationale":"Evaluating a treatment occurs after it has been given."}],"correctOptionId":"A","sourceIds":["OR-ASSESS"],"remediation":"The task is to gather information before making a decision.","reviewedBy":null,"reviewedAt":null},{"id":"placement-w1-task-2","familyId":"placement-w1-task-exception-word","lessonId":"w1-task","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"The question asks which patient statement requires further teaching. What should you look for?","options":[{"id":"A","text":"A statement that repeats the teaching accurately","rationale":"An accurate statement does not identify a teaching gap."},{"id":"B","text":"The longest statement","rationale":"Length does not establish understanding."},{"id":"C","text":"A statement showing a misunderstanding","rationale":"Further teaching is needed where the statement shows a misunderstanding."},{"id":"D","text":"The first statement listed","rationale":"Position in a list does not determine the answer."}],"correctOptionId":"C","sourceIds":["AHRQ-TEACH"],"remediation":"Further teaching is needed where the statement shows a misunderstanding.","reviewedBy":null,"reviewedAt":null},{"id":"placement-w1-task-3","familyId":"placement-w1-task-evaluation-word","lessonId":"w1-task","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"A question asks which finding shows that a comfort measure was effective. What should the answer describe?","options":[{"id":"A","text":"A supply needed for the measure","rationale":"A supply does not demonstrate an outcome."},{"id":"B","text":"A change after the measure that meets its goal","rationale":"Effectiveness is evaluated by the resulting change in relation to the goal."},{"id":"C","text":"An instruction given before the measure","rationale":"An instruction does not show the result."},{"id":"D","text":"The name of the person providing care","rationale":"A staff member’s name does not show effectiveness."}],"correctOptionId":"B","sourceIds":["OR-ASSESS","OR-FLUIDASSESS"],"remediation":"Effectiveness is evaluated by the resulting change in relation to the goal.","reviewedBy":null,"reviewedAt":null},{"id":"placement-w1-chart-1","familyId":"placement-w1-chart-source-distinction","lessonId":"w1-chart","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"Which chart statement clearly identifies a patient-reported symptom?","options":[{"id":"A","text":"The patient reports feeling nauseated.","rationale":"This identifies the patient as the source of a symptom."},{"id":"B","text":"The nurse counted 18 breaths/min.","rationale":"This is an observation measured by the nurse."},{"id":"C","text":"The thermometer reads 37.1 °C.","rationale":"This is a measured temperature."},{"id":"D","text":"The measured urine volume is 240 mL.","rationale":"This is a measured volume."}],"correctOptionId":"A","sourceIds":["OR-ASSESS","OR-DOC"],"remediation":"This identifies the patient as the source of a symptom.","reviewedBy":null,"reviewedAt":null},{"id":"placement-w1-chart-2","familyId":"placement-w1-chart-missing-entry","lessonId":"w1-chart","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"A chart has no pain assessment entry at noon. Which conclusion is justified?","options":[{"id":"A","text":"There was no pain at noon.","rationale":"A missing entry is not evidence of no pain."},{"id":"B","text":"The patient refused assessment.","rationale":"No refusal was documented."},{"id":"C","text":"The last pain medicine was effective.","rationale":"No outcome was documented at noon."},{"id":"D","text":"The chart does not tell us the patient’s pain at noon.","rationale":"The missing entry leaves the noon pain assessment unknown."}],"correctOptionId":"D","sourceIds":["OR-ASSESS","OR-DOC"],"remediation":"The missing entry leaves the noon pain assessment unknown.","reviewedBy":null,"reviewedAt":null},{"id":"placement-w1-chart-3","familyId":"placement-w1-chart-units-and-time","lessonId":"w1-chart","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"At 07:00 the recorded temperature was 37.0 °C. At 11:00 it was 37.8 °C. Which note preserves the measured change?","options":[{"id":"A","text":"Temperature fell 0.8 °C in four hours.","rationale":"The direction was an increase."},{"id":"B","text":"Temperature rose 0.8 °C in four hours.","rationale":"37.8 minus 37.0 is 0.8 °C, across four hours."},{"id":"C","text":"Temperature rose 0.8 °F in one hour.","rationale":"Both the unit and interval have been changed."},{"id":"D","text":"The temperature change proves an infection.","rationale":"A temperature trend alone does not prove the cause."}],"correctOptionId":"B","sourceIds":["OR-DOC","OR-ASSESS"],"remediation":"37.8 minus 37.0 is 0.8 °C, across four hours.","reviewedBy":null,"reviewedAt":null},{"id":"placement-w1-units-1","familyId":"placement-w1-units-sum-volume","lessonId":"w1-units","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"An oral-intake record lists 180 mL of tea, 120 mL of water and 90 mL of juice. What is the recorded total?","options":[{"id":"A","text":"210 mL","rationale":"This does not include all three drinks."},{"id":"B","text":"300 mL","rationale":"This includes only the first two drinks."},{"id":"C","text":"390 mL","rationale":"180 + 120 + 90 = 390 mL."},{"id":"D","text":"490 mL","rationale":"The sum is 390 mL, not 490 mL."}],"correctOptionId":"C","sourceIds":["OR-FLUIDASSESS"],"remediation":"180 + 120 + 90 = 390 mL.","reviewedBy":null,"reviewedAt":null},{"id":"placement-w1-units-2","familyId":"placement-w1-units-average-rate","lessonId":"w1-units","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"A complete urine collection contains 300 mL over five hours. What is the average recorded rate?","options":[{"id":"A","text":"60 mL/hour","rationale":"Divide 300 mL by five hours to obtain 60 mL/hour."},{"id":"B","text":"1500 mL/hour","rationale":"Multiplication does not give the average hourly rate."},{"id":"C","text":"300 mL/hour","rationale":"300 mL is the total, not the hourly rate."},{"id":"D","text":"5 mL/hour","rationale":"Five is the number of hours, not the volume per hour."}],"correctOptionId":"A","sourceIds":["OR-FLUIDASSESS"],"remediation":"Divide 300 mL by five hours to obtain 60 mL/hour.","reviewedBy":null,"reviewedAt":null},{"id":"placement-w1-units-3","familyId":"placement-w1-units-balance-boundary","lessonId":"w1-units","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"Recorded intake is 900 mL and measured output is 650 mL during the same interval. Which interpretation is supported?","options":[{"id":"A","text":"The patient’s total body fluid increased by exactly 250 mL.","rationale":"The record does not include every route of fluid loss."},{"id":"B","text":"The recorded intake-minus-output difference is +250 mL; unmeasured losses are not included.","rationale":"900 − 650 = +250 mL for the recorded measurements only."},{"id":"C","text":"Measured output exceeded intake by 250 mL.","rationale":"Intake exceeded measured output."},{"id":"D","text":"The figures alone prove fluid overload.","rationale":"A recorded difference alone does not establish fluid overload."}],"correctOptionId":"B","sourceIds":["OR-FLUID","OR-FLUIDASSESS"],"remediation":"900 − 650 = +250 mL for the recorded measurements only.","reviewedBy":null,"reviewedAt":null},{"id":"placement-w1-safety-1","familyId":"placement-w1-safety-identifier-selection","lessonId":"w1-safety","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"Before a routine blood draw, which pair is appropriate to verify against the order and the patient’s identification?","options":[{"id":"A","text":"Room number and bed letter","rationale":"Location is not a reliable patient identifier."},{"id":"B","text":"Diagnosis and treating clinician","rationale":"These can apply to several patients."},{"id":"C","text":"Full name and date of birth","rationale":"Use two person-specific identifiers, such as full name and date of birth."},{"id":"D","text":"Meal preference and room number","rationale":"A room number and preference do not establish identity."}],"correctOptionId":"C","sourceIds":["OR-IDENTITY","JC-ID"],"remediation":"Use two person-specific identifiers, such as full name and date of birth.","reviewedBy":null,"reviewedAt":null},{"id":"placement-w1-safety-2","familyId":"placement-w1-safety-glove-transition","lessonId":"w1-safety","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"After removing gloves used for care, the nurse is about to touch clean supplies. What is required?","options":[{"id":"A","text":"Perform hand hygiene.","rationale":"Hand hygiene is needed after glove removal."},{"id":"B","text":"Put the used gloves back on.","rationale":"Used gloves can carry contamination."},{"id":"C","text":"Skip hand hygiene if the gloves looked intact.","rationale":"Gloves do not replace hand hygiene."},{"id":"D","text":"Wipe bare hands on the uniform.","rationale":"A uniform is not a hand-hygiene method."}],"correctOptionId":"A","sourceIds":["CDC-CORE"],"remediation":"Hand hygiene is needed after glove removal.","reviewedBy":null,"reviewedAt":null},{"id":"placement-w1-safety-3","familyId":"placement-w1-safety-identity-conflict","lessonId":"w1-safety","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"Before a nonurgent procedure, the patient states a birth date different from the wristband and order. What is the safest response?","options":[{"id":"A","text":"Proceed because the room number matches.","rationale":"A room number does not resolve identity."},{"id":"B","text":"Use the birth date on the order without checking.","rationale":"Choosing one conflicting record leaves the discrepancy unresolved."},{"id":"C","text":"Ask another patient to confirm the identity.","rationale":"Another patient is not a valid verification method."},{"id":"D","text":"Pause and resolve the identification discrepancy according to policy.","rationale":"Resolve conflicting identifiers before the procedure."}],"correctOptionId":"D","sourceIds":["OR-IDENTITY","JC-ID"],"remediation":"Resolve conflicting identifiers before the procedure.","reviewedBy":null,"reviewedAt":null},{"id":"placement-w1-handoff-1","familyId":"placement-w1-handoff-sbar-background","lessonId":"w1-handoff","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"During an SBAR handoff, which information belongs in Background?","options":[{"id":"A","text":"A specific request for the receiver","rationale":"A request belongs in Recommendation."},{"id":"B","text":"Relevant history explaining the current concern","rationale":"Background provides relevant context for the situation."},{"id":"C","text":"Confirmation that a repeated message is correct","rationale":"This is part of check-back."},{"id":"D","text":"An unrelated event from another patient’s care","rationale":"Unrelated information does not explain this concern."}],"correctOptionId":"B","sourceIds":["AHRQ-SBAR"],"remediation":"Background provides relevant context for the situation.","reviewedBy":null,"reviewedAt":null},{"id":"placement-w1-handoff-2","familyId":"placement-w1-handoff-loop-verification","lessonId":"w1-handoff","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"A nurse asks a colleague to report the new measurement directly to the nurse. The colleague repeats the task accurately. What closes the communication loop?","options":[{"id":"A","text":"The nurse confirms that the repeated message is correct.","rationale":"The sender verifies the receiver’s repeated message."},{"id":"B","text":"The colleague ends the conversation without a response.","rationale":"The sender still needs to confirm accuracy."},{"id":"C","text":"The nurse assumes the message was heard.","rationale":"An assumption is not verification."},{"id":"D","text":"The colleague changes the reporting destination.","rationale":"Changing the destination makes the message inaccurate."}],"correctOptionId":"A","sourceIds":["AHRQ-CHECK"],"remediation":"The sender verifies the receiver’s repeated message.","reviewedBy":null,"reviewedAt":null},{"id":"placement-w1-handoff-3","familyId":"placement-w1-handoff-request-explicit","lessonId":"w1-handoff","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"Which handoff statement makes a specific request?","options":[{"id":"A","text":"The patient’s condition seems different.","rationale":"This raises a concern but does not request an action."},{"id":"B","text":"The patient was admitted yesterday.","rationale":"This provides background only."},{"id":"C","text":"Please assess this patient now and tell me the follow-up plan.","rationale":"This specifies both an action and a requested follow-up."},{"id":"D","text":"Several measurements are in the chart.","rationale":"This points to data without stating what is needed."}],"correctOptionId":"C","sourceIds":["AHRQ-SBAR"],"remediation":"This specifies both an action and a requested follow-up.","reviewedBy":null,"reviewedAt":null},{"id":"placement-w1-teachback-1","familyId":"placement-w1-teachback-purpose","lessonId":"w1-teachback","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"Why does a nurse ask a patient to explain a care instruction in their own words?","options":[{"id":"A","text":"To judge the patient’s intelligence","rationale":"Teach-back checks communication, not intelligence."},{"id":"B","text":"To check how clearly the instruction was understood","rationale":"An own-words explanation helps reveal what was understood."},{"id":"C","text":"To make the patient memorize the nurse’s exact words","rationale":"Exact repetition can occur without understanding."},{"id":"D","text":"To replace the patient’s questions","rationale":"Questions should still be welcomed."}],"correctOptionId":"B","sourceIds":["AHRQ-TEACH"],"remediation":"An own-words explanation helps reveal what was understood.","reviewedBy":null,"reviewedAt":null},{"id":"placement-w1-teachback-2","familyId":"placement-w1-teachback-demonstration","lessonId":"w1-teachback","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"After teaching a patient how to use a mobility aid, which request best checks practical understanding?","options":[{"id":"A","text":"Do you agree with everything I said?","rationale":"Agreement does not demonstrate the task."},{"id":"B","text":"Can you promise to remember?","rationale":"A promise does not demonstrate understanding."},{"id":"C","text":"Was the lesson interesting?","rationale":"Enjoyment does not establish understanding."},{"id":"D","text":"Please show me how you will use it.","rationale":"A demonstration lets the nurse observe how the instruction will be used."}],"correctOptionId":"D","sourceIds":["AHRQ-TEACH"],"remediation":"A demonstration lets the nurse observe how the instruction will be used.","reviewedBy":null,"reviewedAt":null},{"id":"placement-w1-teachback-3","familyId":"placement-w1-teachback-repair","lessonId":"w1-teachback","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"During teach-back, a patient describes one part of the plan incorrectly. What should the nurse do?","options":[{"id":"A","text":"Clarify that part in plain language, then ask the patient to explain it again.","rationale":"Focused clarification followed by another check addresses the misunderstanding."},{"id":"B","text":"Repeat every instruction faster.","rationale":"Faster repetition may leave the same gap."},{"id":"C","text":"Record that the patient agreed with the plan.","rationale":"Agreement is different from demonstrated understanding."},{"id":"D","text":"Stop checking because the instruction was already given.","rationale":"Giving information does not guarantee it was understood."}],"correctOptionId":"A","sourceIds":["AHRQ-TEACH"],"remediation":"Focused clarification followed by another check addresses the misunderstanding.","reviewedBy":null,"reviewedAt":null},{"id":"placement-w1-fluid-1","familyId":"placement-w1-fluid-cluster","lessonId":"w1-fluid","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"An adult reports recent vomiting and little fluid intake. The nurse finds a dry mouth and a lower weight measured under comparable conditions. Which concern fits this pattern?","options":[{"id":"A","text":"Possible fluid deficit requiring further assessment","rationale":"The combined loss, intake and assessment cues support concern for a deficit."},{"id":"B","text":"Proven excess fluid volume","rationale":"These supplied cues do not support an excess-fluid interpretation."},{"id":"C","text":"A precise sodium level","rationale":"A sodium value requires additional data."},{"id":"D","text":"Proof that no follow-up is needed","rationale":"The cue cluster warrants assessment and follow-up."}],"correctOptionId":"A","sourceIds":["OR-FLUID","OR-FLUIDASSESS"],"remediation":"The combined loss, intake and assessment cues support concern for a deficit.","reviewedBy":null,"reviewedAt":null},{"id":"placement-w1-fluid-2","familyId":"placement-w1-fluid-weight-quality","lessonId":"w1-fluid","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"Which approach makes two daily weights more useful for comparing fluid-related change?","options":[{"id":"A","text":"Use different scales at different times.","rationale":"Changing conditions makes comparison less reliable."},{"id":"B","text":"Change the patient’s clothing between measurements.","rationale":"Clothing changes can affect the apparent difference."},{"id":"C","text":"Use the same scale, a similar time and similar clothing.","rationale":"Comparable conditions make the trend more interpretable."},{"id":"D","text":"Replace the measurements with an estimated weight.","rationale":"An estimate is not equivalent to a measured trend."}],"correctOptionId":"C","sourceIds":["OR-FLUIDASSESS"],"remediation":"Comparable conditions make the trend more interpretable.","reviewedBy":null,"reviewedAt":null},{"id":"placement-w1-fluid-3","familyId":"placement-w1-fluid-uncertainty","lessonId":"w1-fluid","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"A patient has new ankle swelling. No recent weights, intake/output record or other assessment findings are available. What can the nurse conclude?","options":[{"id":"A","text":"The exact amount of excess fluid is known.","rationale":"One cue cannot quantify the total fluid change."},{"id":"B","text":"No assessment is needed if swelling is visible.","rationale":"Visible swelling does not replace assessment."},{"id":"C","text":"The cause is definitely heart failure.","rationale":"This finding alone does not establish that diagnosis."},{"id":"D","text":"Swelling is an observed cue, but more assessment is needed to interpret the cause and fluid status.","rationale":"Combine the cue with further history and assessment before drawing a broader conclusion."}],"correctOptionId":"D","sourceIds":["OR-ASSESS","OR-FLUIDASSESS"],"remediation":"Combine the cue with further history and assessment before drawing a broader conclusion.","reviewedBy":null,"reviewedAt":null},{"id":"placement-w1-case-1","familyId":"placement-w1-case-observation-inference","lessonId":"w1-case","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"The nurse hears a patient say, “I feel lightheaded,” and measures a pulse of 108/min. Which statement separates evidence from interpretation?","options":[{"id":"A","text":"The patient definitely has one specific disease.","rationale":"The observations do not establish a specific diagnosis."},{"id":"B","text":"The patient reports lightheadedness and has a measured pulse of 108/min; the cause needs assessment.","rationale":"The report and measurement are evidence; the cause remains uncertain."},{"id":"C","text":"The patient has no symptoms because only one pulse was measured.","rationale":"The patient has reported a symptom."},{"id":"D","text":"The pulse proves that fluid treatment has worked.","rationale":"No treatment or response data are supplied."}],"correctOptionId":"B","sourceIds":["OR-ASSESS","OR-DOC"],"remediation":"The report and measurement are evidence; the cause remains uncertain.","reviewedBy":null,"reviewedAt":null},{"id":"placement-w1-case-2","familyId":"placement-w1-case-followup-request","lessonId":"w1-case","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"A nurse reports new dizziness with a downward blood-pressure trend. Which statement adds an explicit next step to the report?","options":[{"id":"A","text":"I have written several notes.","rationale":"Documentation alone does not request a response."},{"id":"B","text":"The patient’s name is on the chart.","rationale":"Identification is necessary but does not specify the requested response."},{"id":"C","text":"Please assess the patient now and clarify the immediate monitoring plan.","rationale":"The request identifies a timely action and the plan needing clarification."},{"id":"D","text":"Someone may want to look later.","rationale":"This leaves both responsibility and timing unclear."}],"correctOptionId":"C","sourceIds":["AHRQ-SBAR"],"remediation":"The request identifies a timely action and the plan needing clarification.","reviewedBy":null,"reviewedAt":null},{"id":"placement-w1-case-3","familyId":"placement-w1-case-reevaluation","lessonId":"w1-case","role":"placement","status":"draft_needs_clinical_review","context":"","stem":"After an intervention, the patient says dizziness is better, but no new vital signs have been measured. Which evaluation is justified?","options":[{"id":"A","text":"The reported symptom improved; reassessment is needed to evaluate other responses.","rationale":"A symptom report is useful, while other responses remain unmeasured."},{"id":"B","text":"Every measure has returned to normal.","rationale":"No new measurements support this conclusion."},{"id":"C","text":"The intervention has definitely corrected the cause.","rationale":"Improvement in one symptom does not prove the cause is corrected."},{"id":"D","text":"The earlier measurements can be recorded again as current.","rationale":"Earlier values must not be represented as newly measured."}],"correctOptionId":"A","sourceIds":["OR-ASSESS","OR-DOC"],"remediation":"A symptom report is useful, while other responses remain unmeasured.","reviewedBy":null,"reviewedAt":null}]},"sources":[{"id":"OR-DOC","title":"Open RN Nursing Fundamentals 2e — 2.5 Documentation","url":"https://wtcs.pressbooks.pub/nursingfundamentals/chapter/2-5-documentation/","section":"Electronic Health Records; Legal Documentation","accessed":"2026-10-09","license":"Text adapted under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/); exceptions checked: no third-party figures, questions, tables, or videos reproduced. Original cases and plain-English scaffolds added. No endorsement.","claimSupport":"Factual, dated documentation; distinguish observations from assumptions; records contain specific sections.","author":"Open RN | WisTech Open","attribution":"Open RN Nursing Fundamentals 2e — 2.5 Documentation, Open RN | WisTech Open. Adapted under CC BY 4.0; see license and exact chapter link."},{"id":"OR-ASSESS","title":"Open RN Nursing Fundamentals 2e — 4.3 Assessment","url":"https://wtcs.pressbooks.pub/nursingfundamentals/chapter/4-3-assessment/","section":"Subjective Assessment Data; Objective Assessment Data; Sources of Assessment Data / Interviewing","accessed":"2026-10-09","license":"Text adapted under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/); exceptions checked: no third-party figures, questions, tables, or videos reproduced. Original cases and plain-English scaffolds added. No endorsement.","claimSupport":"Patient reports and directly observed measurements are different sources; verify incomplete or inconsistent information.","author":"Open RN | WisTech Open","attribution":"Open RN Nursing Fundamentals 2e — 4.3 Assessment, Open RN | WisTech Open. Adapted under CC BY 4.0; see license and exact chapter link."},{"id":"OR-FLUID","title":"Open RN Nursing Fundamentals 2e — 15.2 Basic Fluid and Electrolyte Concepts","url":"https://wtcs.pressbooks.pub/nursingfundamentals/chapter/15-2-basic-fluid-and-electrolyte-concepts/","section":"Fluid and Electrolyte Regulation; Fluid Imbalance / Excessive Fluid Volume and Deficient Fluid Volume","accessed":"2026-10-09","license":"Text adapted under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/); exceptions checked: no third-party figures, questions, tables, or videos reproduced. Original cases and plain-English scaffolds added. No endorsement.","claimSupport":"Fluid loss/intake mechanisms; deficit and excess cue associations; low urine output can occur with dehydration or kidney dysfunction.","author":"Open RN | WisTech Open","attribution":"Open RN Nursing Fundamentals 2e — 15.2 Basic Fluid and Electrolyte Concepts, Open RN | WisTech Open. Adapted under CC BY 4.0; see license and exact chapter link."},{"id":"OR-FLUIDASSESS","title":"Open RN Nursing Fundamentals 2e — 15.6 Applying the Nursing Process","url":"https://wtcs.pressbooks.pub/nursingfundamentals/chapter/15-6-applying-the-nursing-process/","section":"Assessment / Subjective Assessment and Objective Assessment; Table 15.6a inspected, not reproduced","accessed":"2026-10-09","license":"Text adapted under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/); exceptions checked: no third-party figures, questions, tables, or videos reproduced. Original cases and plain-English scaffolds added. No endorsement.","claimSupport":"Cluster history, comparable weights, intake/output and examination; edema can coexist with intravascular deficit. No treatment thresholds adopted.","author":"Open RN | WisTech Open","attribution":"Open RN Nursing Fundamentals 2e — 15.6 Applying the Nursing Process, Open RN | WisTech Open. Adapted under CC BY 4.0; see license and exact chapter link."},{"id":"OR-IDENTITY","title":"Open RN Nursing Skills 2e — 1.2 Initiating Patient Interaction","url":"https://wtcs.pressbooks.pub/nursingskills/chapter/1-2-initiating-patient-interaction/","section":"Hand Hygiene and Infection Prevention; Patient Identification","accessed":"2026-10-09","license":"Text adapted under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/); exceptions checked: no third-party figures, questions, tables, or videos reproduced. Original cases and plain-English scaffolds added. No endorsement.","claimSupport":"Verify two patient identifiers and match stated identifiers with chart/wristband; hand hygiene before contact and after gloves.","author":"Open RN | WisTech Open","attribution":"Open RN Nursing Skills 2e — 1.2 Initiating Patient Interaction, Open RN | WisTech Open. Adapted under CC BY 4.0; see license and exact chapter link."},{"id":"JC-ID","title":"Joint Commission — Two Patient Identifiers: Understanding the Requirements","url":"https://www.jointcommission.org/en-us/knowledge-library/support-center/standards-interpretation/standards-faqs/000001463","section":"Intent; Armbands; Non-communicative Patients/Residents; last updated April 21, 2026","accessed":"2026-10-09","license":"Reference facts only; original Turno examples. No source assets reproduced.","claimSupport":"Independent authority for person-specific identifiers, exclusion of room number, and local processes for non-communicative patients."},{"id":"CDC-CORE","title":"CDC — Core Infection Prevention and Control Practices","url":"https://www.cdc.gov/infection-control/hcp/core-practices/index.html","section":"5 Standard Precautions; 5a Hand Hygiene; 5d Risk Assessment with Appropriate Use of PPE","accessed":"2026-10-09","license":"Reference facts only; original Turno examples. No source assets reproduced.","claimSupport":"Hand hygiene before patient touch and immediately after glove removal; soap/water for visibly soiled hands; no glove reuse between patients."},{"id":"AHRQ-SBAR","title":"AHRQ TeamSTEPPS — SBAR","url":"https://www.ahrq.gov/teamstepps-program/curriculum/communication/tools/sbar.html","section":"Definition; Using SBAR effectively requires careful attention to each step; Additional notes","accessed":"2026-10-09","license":"Reference facts only; original Turno examples. No source assets reproduced.","claimSupport":"Communicate current situation, relevant background, assessment and explicit request; adaptable structure, not a rigid emergency algorithm."},{"id":"AHRQ-CHECK","title":"AHRQ TeamSTEPPS — Check-Back","url":"https://www.ahrq.gov/teamstepps-program/curriculum/communication/tools/checkback.html","section":"Definition and closed-loop explanation; steps in the check-back process","accessed":"2026-10-09","license":"Reference facts only; original Turno examples. No source assets reproduced.","claimSupport":"Receiver repeats the relevant message; original sender verifies or corrects it. Acknowledgment alone does not verify content."},{"id":"AHRQ-TEACH","title":"AHRQ TeamSTEPPS — Teach-Back","url":"https://www.ahrq.gov/teamstepps-program/curriculum/communication/tools/teachback.html","section":"Definition; own-words understanding check; interpreter paragraph","accessed":"2026-10-09","license":"Reference facts only; original Turno examples. No source assets reproduced.","claimSupport":"Patient explains intended action in their own words; yes/no agreement is insufficient evidence of comprehension."}],"baseline":[{"id":"TASK-D1","familyId":"TASK-BASE-FOLLOWUP","role":"diagnostic","lessonId":"w1-task","stem":"What decision does the prompt request?","context":"A stem asks: “Which information should the nurse obtain to compare the patient’s appetite with the usual pattern?”","chart":null,"options":[{"id":"A","text":"Which meal plan to prescribe.","rationale":"The task asks for comparison information, not a prescription."},{"id":"B","text":"Which diagnosis explains the appetite.","rationale":"A cause is not the requested information."},{"id":"C","text":"Whether all food should be withheld.","rationale":"This introduces an unsupported intervention."},{"id":"D","text":"What the patient normally eats and how current intake differs.","rationale":"Correct. These facts establish the reference and the change."}],"correctOptionId":"D","remediation":"Name the task and comparison before considering clinical explanations.","sourceIds":["OR-ASSESS"],"reviewedBy":null,"reviewedAt":null},{"id":"CHART-D1","familyId":"CHART-BASE-REPORTED","role":"diagnostic","lessonId":"w1-chart","stem":"Which entry clearly identifies a patient-reported finding?","context":"The nurse is summarizing an assessment.","chart":null,"options":[{"id":"A","text":"Respiratory rate measured at 18/min.","rationale":"This is a measured observation."},{"id":"B","text":"Patient states, “My mouth feels dry.”","rationale":"Correct. The source is explicitly the patient."},{"id":"C","text":"The patient must be dehydrated.","rationale":"This is an interpretation, not a reported finding."},{"id":"D","text":"No concerns because the symptom box is empty.","rationale":"A blank field does not establish absence."}],"correctOptionId":"B","remediation":"Look for who supplied the information; label inference separately.","sourceIds":["OR-ASSESS","OR-DOC"],"reviewedBy":null,"reviewedAt":null},{"id":"UNITS-D1","familyId":"UNITS-BASE-RATE","role":"diagnostic","lessonId":"w1-units","stem":"What is the average measured urine output rate for this interval?","context":"A complete collection contains 420 mL over 7 hours. This question asks only for the recorded average rate.","chart":null,"options":[{"id":"A","text":"420 mL/hour","rationale":"That is the whole collection volume, not the hourly average."},{"id":"B","text":"2,940 mL/hour","rationale":"Multiplication does not calculate the average rate."},{"id":"C","text":"60 mL/hour","rationale":"Correct. 420 ÷ 7 = 60 mL/hour."},{"id":"D","text":"0.06 mL/hour","rationale":"0.06 is the rate in liters per hour; labeling it mL/hour introduces a factor-of-1,000 error."}],"correctOptionId":"C","remediation":"Divide volume by time and keep both units.","sourceIds":["OR-FLUIDASSESS"],"reviewedBy":null,"reviewedAt":null},{"id":"SAFE-D1","familyId":"SAFE-BASE-OUTPATIENT","role":"diagnostic","lessonId":"w1-safety","stem":"Which pair provides two person-specific identifiers for this check?","context":"An outpatient clinic uses full name and date of birth in its approved identification process. The alert patient has no wristband.","chart":null,"options":[{"id":"A","text":"Full name and waiting-room chair number.","rationale":"Chair number is a location."},{"id":"B","text":"Appointment time and room number.","rationale":"These describe scheduling and location."},{"id":"C","text":"The same full name read twice.","rationale":"Repeating one identifier does not create a second one."},{"id":"D","text":"Full name and date of birth, matched with the intended record.","rationale":"Correct. The supplied process checks two different person-specific identifiers."}],"correctOptionId":"D","remediation":"Count distinct personal details, not the number of times they are repeated.","sourceIds":["OR-IDENTITY","JC-ID"],"reviewedBy":null,"reviewedAt":null},{"id":"HAND-D1","familyId":"HAND-BASE-RECEIPT","role":"diagnostic","lessonId":"w1-handoff","stem":"Which exchange demonstrates a completed check-back?","context":"A team is confirming a routine follow-up message.","chart":null,"options":[{"id":"A","text":"Sender gives the task; receiver nods.","rationale":"The content understood is not demonstrated."},{"id":"B","text":"Sender gives the task; receiver repeats its content accurately; sender confirms.","rationale":"Correct. The content is returned and verified."},{"id":"C","text":"Sender writes a message; nobody replies.","rationale":"Receipt and understanding are unconfirmed."},{"id":"D","text":"Receiver repeats a different time; sender leaves.","rationale":"The mismatch is unresolved."}],"correctOptionId":"B","remediation":"Look for all three turns and agreement in the message.","sourceIds":["AHRQ-CHECK"],"reviewedBy":null,"reviewedAt":null},{"id":"TEACH-D1","familyId":"TEACH-BASE-DEMONSTRATION","role":"diagnostic","lessonId":"w1-teachback","stem":"Which response provides the clearest evidence of understanding this action?","context":"In a simulation, the nurse demonstrates how to press a bedside call button. The patient is able to use the device.","chart":null,"options":[{"id":"A","text":"The patient smiles.","rationale":"A smile does not demonstrate use of the device."},{"id":"B","text":"The patient says the nurse spoke clearly.","rationale":"This is a positive opinion, not a demonstration."},{"id":"C","text":"The patient copies the word “button.”","rationale":"Repeating a label does not demonstrate the action."},{"id":"D","text":"The patient shows which button they would press to call for help.","rationale":"Correct. The action is demonstrated."}],"correctOptionId":"D","remediation":"Match the evidence to the skill: an action can be checked by showing it.","sourceIds":["AHRQ-TEACH"],"reviewedBy":null,"reviewedAt":null},{"id":"FLUID-D1","familyId":"FLUID-BASE-AMBIGUOUS-URINE","role":"diagnostic","lessonId":"w1-fluid","stem":"What can the nurse conclude from this information alone?","context":"The only new entry is “Urine output is lower than the previous shift.” Collection duration, intake, weight and examination findings are missing.","chart":null,"options":[{"id":"A","text":"The fluid-volume direction is not established; clarify the interval and obtain related assessment data.","rationale":"Correct. The isolated comparison lacks both measurement context and corroborating cues."},{"id":"B","text":"Fluid deficit is confirmed.","rationale":"Reduced urine can have more than one explanation."},{"id":"C","text":"Fluid excess is confirmed.","rationale":"Reduced urine alone does not establish retention."},{"id":"D","text":"The patient must receive a specific volume of fluid.","rationale":"The supplied information cannot justify a prescription."}],"correctOptionId":"A","remediation":"Do not choose a whole-body pattern from one ambiguous measurement.","sourceIds":["OR-FLUID","OR-FLUIDASSESS"],"reviewedBy":null,"reviewedAt":null},{"id":"CASE-D1","familyId":"CASE-BASE-MOBILITY-EVALUATION","role":"diagnostic","lessonId":"w1-case","stem":"Which conclusion stays within the new evidence?","context":"Earlier, a patient reported difficulty walking to the bathroom. Later the patient says, “My legs feel stronger.” Walking has not yet been reassessed.","chart":null,"options":[{"id":"A","text":"Independent walking is confirmed.","rationale":"Feeling stronger does not demonstrate the walking task."},{"id":"B","text":"The patient reports improvement in strength; walking ability still needs assessment.","rationale":"Correct. The report is preserved without assuming functional performance."},{"id":"C","text":"The patient’s earlier report was false.","rationale":"A change does not establish an earlier report was false."},{"id":"D","text":"No useful information was obtained.","rationale":"A reported change is useful, though incomplete, information."}],"correctOptionId":"B","remediation":"Separate an improved feeling from a demonstrated functional result.","sourceIds":["OR-ASSESS","OR-DOC"],"reviewedBy":null,"reviewedAt":null}],"lessons":[{"id":"w1-task","title":"Read the decision","subtitle":"Find the task before you solve the case.","week":1,"day":1,"minutes":12,"domain":"Management of Care","skillIds":["MOC01","MOC03"],"objective":"Restate the requested decision, including a timing or negation word, without replacing it with a different clinical task.","prerequisites":["Read a short English sentence.","Explain the difference between before and after."],"englishTerms":[{"term":"requires follow-up","meaning":"Needs another check or response."},{"term":"most supported","meaning":"Best fits the supplied evidence; not absolute proof."},{"term":"except","meaning":"Signals the one option that does not belong."}],"retrieval":{"prompt":"A question asks which statement needs clarification. Are you selecting the clearest statement or the statement with an unresolved meaning?","answer":"Select the statement with unresolved meaning. You are identifying a communication gap, not making a treatment decision."},"explanation":["A question has a patient story and a job for you to do. Name that job in one sentence: “I must identify a missing fact,” “I must compare changes,” or “I must choose a response.” A true fact can still be the wrong answer when it solves a different job.","Circle the action word and any limit: first, before, after, except, or needs clarification. Then connect the answer to the exact information supplied. “Not documented” means the record does not tell you; it does not prove the patient has no symptom. Open RN describes checking incomplete information with the patient.","When a stem asks what the record supports, preserve uncertainty. An observation can justify further assessment without establishing a diagnosis. This lesson practices English task interpretation. Its word strategy is an original teaching aid, not an official NCLEX test-taking rule."],"bridgeEnglish":"Say the task in plain English before answering: what must I identify, compare or decide? Preserve words such as before, after and NOT. A missing entry is unknown, not proof that a symptom is absent.","workedExample":{"title":"The unanswered comparison","context":"A note says: “The patient feels weaker today.” The question asks which information is needed to interpret “weaker.”","chart":null,"reasoning":["The requested job is to clarify a comparison.","Ask what the patient could do previously and what is different now.","A disease label or a medication choice does not supply that missing reference."],"familyId":"TASK-WORKED-REFERENCE"},"questions":[{"id":"TASK-T1","familyId":"TASK-TEACH-SYMPTOM","role":"teaching","lessonId":"w1-task","stem":"What job is this question asking you to do?","context":"A question reads: “Which patient statement requires clarification before the nurse can describe the change in sleep?”","chart":null,"options":[{"id":"A","text":"Select a treatment for insomnia.","rationale":"The prompt asks for clarification, not treatment."},{"id":"B","text":"Identify a statement whose meaning or comparison is incomplete.","rationale":"Correct. The task is to locate the information gap before describing change."},{"id":"C","text":"Decide whether the patient is being truthful.","rationale":"Clarification does not imply dishonesty."},{"id":"D","text":"Select the statement that already supplies a clear comparison.","rationale":"The qualifier asks for the unresolved statement, not the one that is already complete."}],"correctOptionId":"B","remediation":"Underline “requires clarification” and “before.” Restate the task with no disease name.","sourceIds":["OR-ASSESS"],"reviewedBy":null,"reviewedAt":null},{"id":"TASK-T2","familyId":"TASK-TEACH-NEGATION","role":"teaching","lessonId":"w1-task","stem":"Which note does NOT provide evidence that walking ability improved?","context":"This is a reading exercise. Yesterday the patient walked 20 meters with one helper; improvement means more distance or less assistance under comparable conditions.","chart":null,"options":[{"id":"A","text":"Today: 35 meters with one helper.","rationale":"Under the supplied definition, the larger distance supports improvement."},{"id":"B","text":"Today: 20 meters without a helper.","rationale":"Under the supplied definition, less assistance supports improvement."},{"id":"C","text":"Today: walking not assessed.","rationale":"Correct. No assessment supplies no comparison; it does not show worsening either."},{"id":"D","text":"Today: 30 meters without a helper.","rationale":"Both changes support the supplied definition of improvement."}],"correctOptionId":"C","remediation":"Rewrite NOT as “the one that does not show.” Separate missing evidence from a negative result.","sourceIds":["OR-DOC","OR-ASSESS"],"reviewedBy":null,"reviewedAt":null}],"delayed":{"prompt":"Tomorrow, explain the difference between “Which finding supports the concern?” and “Which action should happen next?”","answer":"The first asks for evidence; the second asks for an action. Give one example of each without opening the lesson."},"sourceIds":["OR-ASSESS","OR-DOC"],"status":"draft_needs_clinical_review"},{"id":"w1-chart","title":"Make the chart tell the truth","subtitle":"Time, source, unit, comparison.","week":1,"day":1,"minutes":12,"domain":"Basic Care and Comfort","skillIds":["BCC01","BCC02","MOC04","SIPC01"],"objective":"Describe a chart trend with a baseline, time interval, units and source, while keeping missing data visible.","prerequisites":["Restate the question’s task.","Compare two decimal numbers."],"englishTerms":[{"term":"baseline","meaning":"The stated earlier reference for comparison."},{"term":"reports","meaning":"Information stated by the patient or another identified person."},{"term":"not assessed","meaning":"This observation was not performed or recorded here."}],"retrieval":{"prompt":"A patient says, “I feel warm”; a thermometer reads 37.1 °C. Which is reported and which is measured?","answer":"Feeling warm is the patient’s report. 37.1 °C is the measured temperature. Neither erases the other."},"explanation":["Read each chart entry as a small package: what was measured or reported, when, in which units, and by whom. A trend compares observations over time. A single value has no direction by itself.","Keep patient experience and observed measurements together while labeling their sources. “The patient reports dizziness” is more precise than inventing a cause. A blank cell is unknown; “no dizziness reported after the nurse asked” is a different statement.","Check whether the measurements can fairly be compared. For daily weight, Open RN specifies the same scale, similar clothing and the same time of day. If the conditions differ, describe the recorded difference and the uncertainty before treating it as a physiologic change."],"bridgeEnglish":"Build one sentence: what changed, from which value to which value, over what interval, and who reported or measured it? State which comparison or earlier finding is missing.","workedExample":{"title":"Two numbers, one careful sentence","context":"An adult is being assessed; no treatment decision is requested. Both pulse measurements were obtained at rest.","chart":{"columns":["Observation","08:00","12:00"],"rows":[["Pulse","76/min","92/min"],["Dizziness","Not documented","Patient reports dizziness"]]},"reasoning":["Pulse increased from 76/min at 08:00 to 92/min at 12:00.","The patient reported dizziness at 12:00; the 08:00 symptom cell is not documented.","Do not call the dizziness “new” unless earlier absence or onset is established."],"familyId":"CHART-TEACH-PULSE"},"questions":[{"id":"CHART-T1","familyId":"CHART-TEACH-PULSE","role":"teaching","lessonId":"w1-chart","stem":"Which statement accurately describes the chart?","context":"Both measurements were at rest. No symptom information was collected at 09:00.","chart":{"columns":["Observation","09:00","13:00"],"rows":[["Pulse","72/min","88/min"],["Dizziness","Not collected","Patient reports dizziness"]]},"options":[{"id":"A","text":"Pulse decreased by 16/min.","rationale":"The later number is higher, not lower."},{"id":"B","text":"New dizziness caused the pulse change.","rationale":"Neither new onset nor causation is established."},{"id":"C","text":"Pulse increased from 72/min to 88/min over four hours; dizziness was reported at 13:00.","rationale":"Correct. Direction, time, units and source are preserved."},{"id":"D","text":"The patient had no dizziness at 09:00.","rationale":"That entry is missing, not negative."}],"correctOptionId":"C","remediation":"Point to the earlier and later cells; say what is known about symptoms separately.","sourceIds":["OR-DOC","OR-ASSESS"],"caseFamilyId":"CHART-TEACH-PULSE","exposureNote":"Worked example or a close scenario variant was presented during this lesson; use as guided practice, not fresh-family acquisition evidence.","reviewedBy":null,"reviewedAt":null},{"id":"CHART-T2","familyId":"CHART-TEACH-SCALE","role":"teaching","lessonId":"w1-chart","stem":"What most limits interpretation of the recorded weight increase?","context":"Yesterday’s weight was 71.0 kg on a standing scale in a gown. Today’s was 72.1 kg on a bed scale with bedding; the bedding adjustment is not documented.","chart":null,"options":[{"id":"A","text":"The measurement conditions differ.","rationale":"Correct. Scale and clothing/bedding differences limit a physiologic interpretation."},{"id":"B","text":"The values use the same unit, so the measurement conditions do not matter.","rationale":"Matching units do not remove the differences in scale, clothing and bedding."},{"id":"C","text":"Two dated values always prove fluid gain.","rationale":"A recorded change is not automatically a body-fluid change."},{"id":"D","text":"Subtract an estimated bedding weight and accept the corrected trend.","rationale":"An unverified estimate does not establish comparable measurements; clarify how the bed scale was adjusted."}],"correctOptionId":"A","remediation":"List scale, time and clothing before interpreting the difference.","sourceIds":["OR-FLUIDASSESS","OR-DOC"],"reviewedBy":null,"reviewedAt":null}],"delayed":{"prompt":"Tomorrow, write a trend sentence using 07:00 = 65.2 kg and next day 07:00 = 64.7 kg, same scale and similar clothes.","answer":"Weight decreased by 0.5 kg over 24 hours under comparable measurement conditions. This statement alone does not establish the cause."},"sourceIds":["OR-ASSESS","OR-DOC","OR-FLUIDASSESS"],"status":"draft_needs_clinical_review"},{"id":"w1-units","title":"Keep the units attached","subtitle":"A number becomes useful when its meaning travels with it.","week":1,"day":2,"minutes":14,"domain":"Reduction of Risk Potential","skillIds":["PPT03","PPT04","BCC07","RRP01"],"objective":"Calculate a recorded intake-minus-output difference or an average rate using the supplied interval and explain the boundary of that result.","prerequisites":["Add and subtract whole numbers.","Read mL and hour."],"englishTerms":[{"term":"intake","meaning":"The fluid amount entering through the routes included in the record."},{"term":"measured output","meaning":"The losses actually quantified in the supplied record."},{"term":"per hour","meaning":"An average amount for each hour of the stated period."}],"retrieval":{"prompt":"If 480 mL is collected over 6 hours, what calculation gives the average mL/hour?","answer":"480 mL ÷ 6 hours = 80 mL/hour. This is an average, not a statement that each hour was identical."},"explanation":["Write the requested unit before calculating. A total volume stays in mL. An average rate is volume divided by time, so its unit is mL/hour. A conversion changes the written unit without changing the amount; use 1 L = 1,000 mL in these exercises.","For a recorded balance, subtract the measured output from the recorded intake for the same period. Positive means recorded intake exceeds measured output. Negative means measured output exceeds recorded intake. Include every listed measured output route; do not silently use urine alone when another route is supplied.","The subtraction describes this record. Unmeasured losses, missed entries and inconsistent collection periods can make it different from total body-water change. It does not choose a fluid prescription or establish a diagnosis. These are measurement exercises, not medication-dosing lessons."],"bridgeEnglish":"Write the required unit first. Divide volume by hours for an average rate. For recorded balance, subtract every listed measured output from intake for the same period; the result does not include every body-water loss.","workedExample":{"title":"A complete measured window","context":"During one 8-hour interval, intake is 900 mL; urine is 500 mL; measured emesis is 150 mL.","chart":null,"reasoning":["Measured output = 500 + 150 = 650 mL.","Recorded balance = 900 − 650 = +250 mL over 8 hours.","This is the recorded difference. It does not include every unmeasured loss or prescribe replacement."],"familyId":"UNITS-TEACH-BALANCE"},"questions":[{"id":"UNITS-T1","familyId":"UNITS-TEACH-BALANCE","role":"teaching","lessonId":"w1-units","stem":"What is the recorded intake-minus-measured-output difference?","context":"For the same shift: oral intake 650 mL, IV intake 400 mL, urine 700 mL, measured emesis 100 mL.","chart":null,"options":[{"id":"A","text":"+250 mL","rationale":"Correct. Intake 1,050 minus measured output 800 equals +250 mL."},{"id":"B","text":"+350 mL","rationale":"This omits the 100 mL emesis from measured output."},{"id":"C","text":"−250 mL","rationale":"This reverses the requested subtraction."},{"id":"D","text":"1,850 mL","rationale":"This adds input and output instead of finding the difference."}],"correctOptionId":"A","remediation":"Make one intake column and one measured-output column, total each, then subtract.","sourceIds":["OR-FLUIDASSESS"],"caseFamilyId":"UNITS-TEACH-BALANCE","exposureNote":"Worked example or a close scenario variant was presented during this lesson; use as guided practice, not fresh-family acquisition evidence.","reviewedBy":null,"reviewedAt":null},{"id":"UNITS-T2","familyId":"UNITS-TEACH-CONVERSION","role":"teaching","lessonId":"w1-units","stem":"How many milliliters were recorded as oral intake?","context":"The record lists 0.75 L of water and 180 mL of tea. Use 1 L = 1,000 mL. No other oral fluid is listed.","chart":null,"options":[{"id":"A","text":"255 mL","rationale":"0.75 L is 750 mL, not 75 mL."},{"id":"B","text":"750 mL","rationale":"This omits the tea."},{"id":"C","text":"930 mL/hour","rationale":"No duration is supplied and the question asks for total volume."},{"id":"D","text":"930 mL","rationale":"Correct. 750 + 180 = 930 mL."}],"correctOptionId":"D","remediation":"Convert the liters first; then add quantities in the same unit.","sourceIds":["OR-FLUIDASSESS"],"reviewedBy":null,"reviewedAt":null}],"delayed":{"prompt":"In two days, explain why a +300 mL recorded balance cannot automatically be called a 300 mL increase in total body water.","answer":"The record may omit unmeasured losses or entries. Interpret it alongside comparable weights, history and assessment."},"sourceIds":["OR-FLUID","OR-FLUIDASSESS"],"status":"draft_needs_clinical_review"},{"id":"w1-safety","title":"Pause at the mismatch","subtitle":"Verify the person. Protect the next contact.","week":1,"day":2,"minutes":12,"domain":"Safety and Infection Prevention and Control","skillIds":["SIPC02","SIPC03","SIPC05"],"objective":"Recognize an identifier mismatch and select a verification step; apply hand hygiene at a specified care transition.","prerequisites":["Compare names and dates exactly.","Separate a person-specific identifier from a location."],"englishTerms":[{"term":"identifier","meaning":"Person-specific information used to match the person and intended care."},{"term":"mismatch","meaning":"Two entries that should agree do not agree."},{"term":"visibly soiled","meaning":"Dirt or other material can be seen on the hands."}],"retrieval":{"prompt":"Does a room number identify the person, or the location?","answer":"The location. It does not replace a person-specific identifier."},"explanation":["Before a planned nonurgent care activity, match the patient with the intended record using the organization’s approved identification process. Name and date of birth are two person-specific identifiers in these examples. A wristband is a place to find identifiers; simply seeing a band is not two checks.","When the stated name or birth date conflicts with the record, pause that planned activity and resolve the discrepancy through the approved process. Do not choose the convenient version or use the room number to overrule the mismatch. Urgent unidentified-patient situations require their own local process and are outside these examples.","Standard Precautions apply across care settings. Perform hand hygiene before touching a patient and immediately after removing gloves. Use soap and water when hands are visibly soiled. A fresh pair of gloves does not replace cleaning the hands. Our cases do not test organism-specific precautions."],"bridgeEnglish":"Use the approved person-specific identifiers to match the patient and record. Resolve a mismatch before the planned nonurgent activity. At the care transition, check whether hand hygiene is due; gloves do not replace it.","workedExample":{"title":"Same name, different date","context":"Before a routine assessment, the alert patient states Elena Cruz, June 12, 1988. The open chart shows Elena Cruz, June 21, 1988.","chart":null,"reasoning":["The names agree but the birth dates do not.","Pause the routine assessment under that chart and verify the discrepancy using the organization’s identification process.","Do not change the record by guess or assume the similar dates are harmless."],"familyId":"SAFE-TEACH-ID-MISMATCH"},"questions":[{"id":"SAFE-T1","familyId":"SAFE-TEACH-ID-MISMATCH","role":"teaching","lessonId":"w1-safety","stem":"What is the best next step before this nonurgent activity?","context":"For a routine assessment, the patient states Omar Vega, March 8, 1975. The attached band and open chart show Omar Vega, August 3, 1975. The patient is alert and stable.","chart":null,"options":[{"id":"A","text":"Proceed because the name matches.","rationale":"One matching identifier does not resolve the conflicting birth date."},{"id":"B","text":"Use the room number as the deciding identifier.","rationale":"A location does not resolve a person-specific mismatch."},{"id":"C","text":"Pause and resolve the discrepancy through the approved identification process.","rationale":"Correct. The planned activity can wait while identity is verified."},{"id":"D","text":"Change the birth date based only on which version seems more likely.","rationale":"Guessing does not establish the correct record."}],"correctOptionId":"C","remediation":"Read each birth date aloud; identify what conflicts before choosing a response.","sourceIds":["OR-IDENTITY","JC-ID"],"caseFamilyId":"SAFE-TEACH-ID-MISMATCH","exposureNote":"Worked example or a close scenario variant was presented during this lesson; use as guided practice, not fresh-family acquisition evidence.","reviewedBy":null,"reviewedAt":null},{"id":"SAFE-T2","familyId":"SAFE-TEACH-GLOVE-TRANSITION","role":"teaching","lessonId":"w1-safety","stem":"Which action is required at this transition?","context":"The nurse has removed gloves after a care task. Hands are visibly soiled. The next activity is touching another patient.","chart":null,"options":[{"id":"A","text":"Apply new gloves over the unwashed hands.","rationale":"New gloves do not replace hand hygiene."},{"id":"B","text":"Wash hands with soap and water before the next patient contact.","rationale":"Correct. Visible soiling requires soap and water, and this transition requires hand hygiene."},{"id":"C","text":"Use alcohol-based hand rub alone despite the visible soil.","rationale":"For visibly soiled hands, CDC specifies soap and water."},{"id":"D","text":"Wipe away the soil with a dry towel and put on new gloves.","rationale":"A dry towel and new gloves do not replace washing visibly soiled hands with soap and water."}],"correctOptionId":"B","remediation":"Name both triggers: after glove removal and before patient contact; then check for visible soil.","sourceIds":["CDC-CORE","OR-IDENTITY"],"reviewedBy":null,"reviewedAt":null}],"delayed":{"prompt":"Tomorrow, explain why name plus room number is not equivalent to name plus birth date.","answer":"The room describes a changeable location. The birth date is person-specific. The exact verification process must follow the setting’s policy."},"sourceIds":["OR-IDENTITY","JC-ID","CDC-CORE"],"status":"draft_needs_clinical_review"},{"id":"w1-handoff","title":"Make the message land","subtitle":"Organize the concern, then close the loop.","week":1,"day":3,"minutes":20,"domain":"Management of Care","skillIds":["MOC05","MOC06","MOC08","RRP07"],"objective":"Construct a concise concern using SBAR and identify whether a check-back has been completed.","prerequisites":["Distinguish observations from interpretations.","Identify time and follow-up ownership."],"englishTerms":[{"term":"situation","meaning":"What is happening now and why you are communicating."},{"term":"request","meaning":"The response you are asking for and when it is needed."},{"term":"check-back","meaning":"Repeat the message so its sender can verify it."}],"retrieval":{"prompt":"A teammate replies “Okay.” What do you still not know about their understanding?","answer":"You do not know whether they understood the intended task, details and timing. A content check-back can reveal that."},"explanation":["SBAR provides places for the current concern, relevant background, your assessment and a recommendation or request. Lead with why you are communicating. Select details that help the receiver understand the concern; report uncertainty honestly.","A check-back adds a second job: the receiver repeats the relevant message and the sender confirms or corrects it. A nod or “Okay” does not show which meaning was received. If the repeat is wrong, correct it and check again.","The structure helps organize communication; it does not dictate a universal treatment order. Our examples use supplied follow-up tasks, not medication orders or emergency protocols. State who will do a task and how the result returns to the team."],"bridgeEnglish":"Organize the message into what is happening, relevant background, your assessment and the response you need. The receiver repeats the message; the sender confirms or corrects it. A brief agreement alone does not show what was understood.","workedExample":{"title":"A missing measurement","context":"The nurse wants a colleague to repeat an incomplete routine weight measurement at 10:00 and report the result directly.","chart":null,"reasoning":["Situation: “The weight entry is incomplete.” Background: “The daily comparison requires the same scale and similar clothing.”","Assessment: “Today’s entry has no value, so we cannot compare it.” Request: “Please obtain and report the weight at 10:00 using the documented conditions.”","Receiver: “I will obtain the weight at 10:00 using those conditions and report it to you.” Sender: “Correct.”"],"familyId":"HAND-WORKED-MISSING-WEIGHT"},"questions":[{"id":"HAND-T1","familyId":"HAND-TEACH-REQUEST","role":"teaching","lessonId":"w1-handoff","stem":"Which sentence supplies a clear request?","context":"The nurse has already introduced themselves, identified the patient and reported the relevant observations. This exercise asks only for the request portion.","chart":null,"options":[{"id":"A","text":"Please review the assessment with me now and confirm the follow-up plan.","rationale":"Correct. This states a requested response and timing."},{"id":"B","text":"The patient was admitted yesterday.","rationale":"This is background."},{"id":"C","text":"I am concerned about the documented change.","rationale":"This expresses concern but leaves the requested response unstated."},{"id":"D","text":"There are several entries in the chart.","rationale":"This neither prioritizes relevant facts nor requests a response."}],"correctOptionId":"A","remediation":"Complete “I need ___, when ___, with follow-up by ___.”","sourceIds":["AHRQ-SBAR"],"reviewedBy":null,"reviewedAt":null},{"id":"HAND-T2","familyId":"HAND-TEACH-CORRECTION","role":"teaching","lessonId":"w1-handoff","stem":"What should the sender do to close the loop accurately?","context":"Sender: “Please review the new result at 14:00 and call me.” Receiver: “I will review it at 16:00 and call you.”","chart":null,"options":[{"id":"A","text":"Say “Thanks” and end the conversation.","rationale":"This leaves the different time uncorrected."},{"id":"B","text":"Assume 16:00 was a harmless slip.","rationale":"The purpose is to verify the intended message, not assume it."},{"id":"C","text":"Send no further message because the task was repeated.","rationale":"A repeated error still needs correction."},{"id":"D","text":"Clarify the time as 14:00, ask the receiver to repeat it, and verify the message.","rationale":"Correct. The sender resolves the mismatch and confirms the message."}],"correctOptionId":"D","remediation":"Compare the task, time and reporting route word by word.","sourceIds":["AHRQ-CHECK"],"reviewedBy":null,"reviewedAt":null}],"delayed":{"prompt":"Tomorrow, describe the three communication turns that close a check-back.","answer":"Sender gives message; receiver repeats its relevant content; sender confirms or corrects. If corrected, verify the corrected message."},"sourceIds":["AHRQ-SBAR","AHRQ-CHECK","OR-FLUIDASSESS"],"status":"draft_needs_clinical_review"},{"id":"w1-teachback","title":"Hear the understanding","subtitle":"Invite the plan in the patient’s own words.","week":1,"day":4,"minutes":20,"domain":"Health Promotion and Maintenance","skillIds":["HPM01","HPM02","HPM03","PPT08"],"objective":"Choose an own-words understanding check and respond to a specific misunderstanding with focused clarification and another check.","prerequisites":["Distinguish agreement from explanation.","Compare a stated instruction with a patient’s response."],"englishTerms":[{"term":"in your own words","meaning":"Express the meaning without copying the speaker."},{"term":"show me","meaning":"Demonstrate the skill or action."},{"term":"clarify","meaning":"Make an unclear part more understandable."}],"retrieval":{"prompt":"Why does “Yes, I understand” provide less evidence than a patient describing what they will do?","answer":"Agreement does not show the intended action. An explanation can reveal the meaning the patient actually took from the conversation."},"explanation":["Teach-back asks the patient to explain the relevant plan in their own words. Frame it as a check on the clarity of your explanation. For a physical skill, a demonstration can show what the patient will actually do.","Compare the response with the plan you explained. When one detail differs, clarify that detail in plain language and check it again. Repeating a large block of information without identifying the missed part can leave the same misunderstanding hidden.","Communication support should fit the person. AHRQ describes using teach-back with interpreters as well. Do not infer comprehension from accent, fluent conversation or agreement. These examples supply the plan explicitly; the lesson evaluates communication rather than whether a particular treatment plan is appropriate."],"bridgeEnglish":"Ask the person to describe the plan in their own words as a check on your explanation. Clarify the particular detail that differs, then listen again. Do not infer understanding from a nod or an agreeable answer.","workedExample":{"title":"The appointment card","context":"A fictional plan says: “Your follow-up call is Thursday at 09:00. Keep your symptom record available.” The patient says, “I will go to the clinic Friday.”","chart":null,"reasoning":["The response differs in visit format and day. Preparation was not mentioned, so it remains unverified rather than demonstrably wrong.","Clarify: “This visit is a phone call on Thursday at 09:00; have your symptom record beside you.”","Ask the patient to explain when and how the follow-up will occur and what they will have ready."],"familyId":"TEACH-TEACH-APPOINTMENT"},"questions":[{"id":"TEACH-T1","familyId":"TEACH-TEACH-LOG","role":"teaching","lessonId":"w1-teachback","stem":"Which prompt best checks understanding of the stated plan?","context":"A nurse has explained a fictional plan: record the time of each symptom and bring the record to the next visit.","chart":null,"options":[{"id":"A","text":"You understand, right?","rationale":"This invites agreement without demonstrating the plan."},{"id":"B","text":"You will record each symptom and bring the record, correct?","rationale":"This supplies the answer and invites agreement instead of hearing the patient explain the plan."},{"id":"C","text":"To check that I explained clearly, tell me what you will record and what you will bring next time.","rationale":"Correct. It invites the relevant actions in the patient’s own words."},{"id":"D","text":"Repeat my entire paragraph exactly.","rationale":"Word-for-word repetition may not reveal the patient’s meaning."}],"correctOptionId":"C","remediation":"Ask for what the person will do, not a yes/no judgment of understanding.","sourceIds":["AHRQ-TEACH"],"reviewedBy":null,"reviewedAt":null},{"id":"TEACH-T2","familyId":"TEACH-TEACH-APPOINTMENT","role":"teaching","lessonId":"w1-teachback","stem":"What response best addresses the demonstrated misunderstanding?","context":"The supplied instruction is: “Bring your written questions to Monday’s video visit.” The patient says: “I will mail the questions after the visit.”","chart":null,"options":[{"id":"A","text":"Explain that the questions should be available during Monday’s video visit, then ask how the patient will prepare.","rationale":"Correct. The response repairs the timing/action mismatch and checks again."},{"id":"B","text":"Document full understanding because the patient mentioned questions.","rationale":"The patient’s intended timing differs from the plan."},{"id":"C","text":"Repeat the complete instruction once and end the conversation.","rationale":"Re-explanation may help, but ending without another understanding check leaves the mismatch unresolved."},{"id":"D","text":"Ask whether the patient now understands and accept a yes as the completed check.","rationale":"Yes/no agreement does not show whether the intended action and timing were understood."}],"correctOptionId":"A","remediation":"Compare the verbs and timing, then repair only the mismatched parts before checking again.","sourceIds":["AHRQ-TEACH"],"caseFamilyId":"TEACH-TEACH-APPOINTMENT","exposureNote":"Worked example or a close scenario variant was presented during this lesson; use as guided practice, not fresh-family acquisition evidence.","reviewedBy":null,"reviewedAt":null}],"delayed":{"prompt":"Tomorrow, replace “Do you understand how to use the symptom record?” with an own-words check.","answer":"Example: “To check that I explained clearly, tell me what you will put in the record and when.” Accept another nonjudgmental prompt that asks for the intended action."},"sourceIds":["AHRQ-TEACH"],"status":"draft_needs_clinical_review"},{"id":"w1-fluid","title":"Read the whole fluid story","subtitle":"A cue becomes stronger when other evidence agrees.","week":1,"day":5,"minutes":24,"domain":"Physiological Adaptation","skillIds":["PA04","PA07","RRP06","BCC07"],"objective":"Select a fluid-volume pattern from history, comparable weight and examination, and name what the supplied evidence cannot establish.","prerequisites":["Read comparable trends.","Calculate a recorded balance.","Distinguish a supported concern from a confirmed cause."],"englishTerms":[{"term":"retention","meaning":"Fluid remains in the body rather than being eliminated."},{"term":"deficit","meaning":"The available pattern supports fluid loss exceeding replacement."},{"term":"cue cluster","meaning":"Several relevant observations considered together."}],"retrieval":{"prompt":"Can decreased urine output by itself distinguish fluid deficit from excess?","answer":"No. It can occur with dehydration or kidney dysfunction. Assess the context and other findings."},"explanation":["Start with the mechanism: what could be entering, leaving or being retained? Ongoing gastrointestinal losses with little intake support a different explanation from documented kidney dysfunction with a rising comparable weight and new edema.","Combine information from different sources: history, standardized weight trend, measured intake/output, and examination. Low urine output alone is ambiguous. In the adult examples here, thirst and dry oral mucosa fit a deficit pattern, while weight gain with edema and new crackles can fit fluid excess.","Describe the best-supported pattern and its limits. Edema does not guarantee adequate circulating volume; fluid can be outside the vessels while intravascular volume is low. A small chart does not establish electrolyte values, a unique cause, severity or a fluid prescription. Do not turn a cue pattern into an automatic treatment rule."],"bridgeEnglish":"Connect the history with intake and losses, comparable weights and examination. Less urine alone cannot distinguish deficit from excess. State the supported concern and what still needs assessment.","workedExample":{"title":"A pattern after poor replacement","context":"An adult has two days of vomiting, very little oral intake and no documented cardiac or renal disease. The clinical team is assessing the patient. Both morning weights used the same scale and similar clothing.","chart":{"columns":["Finding","Yesterday morning","Today morning"],"rows":[["Weight","66.5 kg","65.7 kg"],["Pulse at rest","80/min","98/min"],["Oral mucosa","Moist","Dry"]]},"reasoning":["Vomiting provides a loss route and poor intake limits replacement.","Weight fell by 0.8 kg; the pulse rose while the mouth became dry.","The converging pattern supports fluid-volume deficit; the chart does not set a replacement prescription."],"familyId":"FLUID-WORKED-VOMITING"},"questions":[{"id":"FLUID-T1","familyId":"FLUID-TEACH-RENAL-RETENTION","role":"teaching","lessonId":"w1-fluid","stem":"Which interpretation best explains the whole supplied pattern?","context":"An adult has documented kidney dysfunction. Both weights used the same scale at the same morning time with similar clothing. The team is assessing the new findings.","chart":{"columns":["Finding","Yesterday","Today"],"rows":[["Weight","75.0 kg","76.3 kg"],["Ankles","No edema","Bilateral pitting edema"],["Lungs","Clear","New basal crackles"],["24-hour urine","1,300 mL","500 mL"]]},"options":[{"id":"A","text":"Deficit is established by the urine volume alone.","rationale":"Low urine volume does not override the weight and examination pattern."},{"id":"B","text":"The combined findings support fluid-volume excess.","rationale":"Correct. Retention context, comparable weight gain, edema and crackles converge."},{"id":"C","text":"The weight gain establishes adequate circulating volume, so the lung findings can be disregarded.","rationale":"Weight gain does not by itself establish intravascular adequacy, and the new lung findings remain relevant to the whole pattern."},{"id":"D","text":"No interpretation is possible without a sodium result.","rationale":"A sodium result can add information but its absence does not erase this cluster."}],"correctOptionId":"B","remediation":"Name one historical cue, the weight trend, and two examination cues before selecting a pattern.","sourceIds":["OR-FLUID","OR-FLUIDASSESS"],"reviewedBy":null,"reviewedAt":null},{"id":"FLUID-T2","familyId":"FLUID-TEACH-DIARRHEA-DEFICIT","role":"teaching","lessonId":"w1-fluid","stem":"Which conclusion is best supported, without exceeding the evidence?","context":"An adult reports frequent watery stools and very little drinking for 36 hours. The patient is thirsty, has dry oral mucosa and reports less urine than usual. No weight or laboratory data are available.","chart":null,"options":[{"id":"A","text":"A specific serum sodium value can be predicted.","rationale":"The case does not provide electrolyte measurements."},{"id":"B","text":"Fluid excess is proved because urine decreased.","rationale":"Decreased urine alone does not establish excess."},{"id":"C","text":"A particular IV-fluid dose is established.","rationale":"Assessment cues do not determine a prescription from this limited record."},{"id":"D","text":"The cluster supports fluid-volume deficit; severity and electrolyte status need further assessment.","rationale":"Correct. The mechanism and corroborating cues support the concern while preserving uncertainty."}],"correctOptionId":"D","remediation":"Link the loss route and limited intake with supporting findings; then state one unknown.","sourceIds":["OR-FLUID","OR-FLUIDASSESS"],"reviewedBy":null,"reviewedAt":null}],"delayed":{"prompt":"In two days, explain why low urine output plus edema requires a broader assessment than low urine output alone.","answer":"Edema adds information about fluid distribution, but neither sign guarantees the intravascular state. Combine history, comparable weight, intake/output and examination."},"sourceIds":["OR-FLUID","OR-FLUIDASSESS"],"status":"draft_needs_clinical_review"},{"id":"w1-case","title":"The first shift: connect the evidence","subtitle":"Notice, explain, communicate, check again.","week":1,"day":6,"minutes":26,"domain":"Reduction of Risk Potential","skillIds":["MOC03","MOC04","MOC05","MOC06","RRP06","PA07","PA08"],"objective":"Use an unfolding adult case to distinguish observations, a supported concern, an explicit request, and the next evidence needed to evaluate change.","prerequisites":["Complete chart, units, handoff and fluid lessons or demonstrate their prerequisite skills."],"englishTerms":[{"term":"working explanation","meaning":"A provisional explanation to be checked against further data."},{"term":"reassess","meaning":"Collect relevant observations again to evaluate change."},{"term":"uncertainty","meaning":"What is not yet established by the available evidence."}],"retrieval":{"prompt":"How is “the patient reports less dizziness” different from “fluid balance is restored”?","answer":"The first is one reported change; the second is a broader conclusion requiring related reassessment evidence."},"explanation":["Keep four layers distinct: what you observed, what you think the observations may mean, what you communicate or request, and what you will look for next. This keeps a plausible explanation from becoming an unsupported certainty.","In an unfolding case, read each new entry against the earlier record. A symptom improving does not automatically establish that the underlying concern is resolved. Updated examination, relevant measurements and patient reports should be considered together.","The worked case is coached practice. Its stages share a case family and do not count as independent demonstrations of skill. Explain the evidence aloud, invite feedback and then reconstruct the explanation with the worked answer hidden. The supplied setting already has a clinical team assessing the patient; no treatment regimen is selected here."],"bridgeEnglish":"Separate the observed finding, the provisional explanation, the request to the team and the evidence needed next. Improvement in one symptom does not by itself show that the whole concern has resolved.","workedExample":{"title":"Coached case: Lina’s morning assessment","context":"Lina is a fictional adult admitted for evaluation after vomiting and poor intake. Identity has been verified. The team is already assessing the patient. Both morning weights used the same scale and similar clothing. No treatment order is supplied.","chart":{"columns":["Finding","Yesterday morning","Today morning"],"rows":[["Weight","70.2 kg","69.4 kg"],["Pulse at rest","82/min","102/min"],["Blood pressure","124/78 mm Hg","108/70 mm Hg"],["Mouth","Moist","Dry"],["Patient report","No thirst reported","“I feel thirsty.”"]]},"reasoning":["Coach pause 1: “Which changes are observations?” Learner names weight 70.2 to 69.4 kg, pulse 82 to 102/min, blood pressure 124/78 to 108/70 mm Hg, and the patient’s new report of thirst. Label the report separately.","Coach pause 2: “Which explanation fits, and why?” Losses and poor replacement with the downward weight trend and dry mouth support a fluid-volume-deficit concern. The explanation does not establish electrolyte status or a unique cause.","Coach pause 3: “Give the message.” Example: “This is the nurse caring for Lina. I am concerned about today’s changes after vomiting and limited intake. Weight fell 0.8 kg under comparable conditions; pulse rose, blood pressure fell, and the mouth is dry. Please review the assessment with me and confirm the monitoring and follow-up plan.” Follow local communication and escalation processes.","Coach pause 4: “What would count as useful next evidence?” A reassessment of the relevant symptom, examination, comparable measurements and recorded intake/output; use whatever timing and plan the responsible team establishes. Do not declare resolution from one reassuring sentence.","Hide the model. Learner gives a 45-second explanation with two observed changes, the mechanism, one unknown and one explicit request. Coach records each component separately and gives one focused repair."],"familyId":"CASE-TEACH-LINA"},"questions":[{"id":"CASE-T1","familyId":"CASE-TEACH-LINA","role":"teaching","lessonId":"w1-case","stem":"Which assessment statement best connects evidence and uncertainty?","context":"Continue the coached Lina case: vomiting and poor intake; weight 70.2 to 69.4 kg under comparable conditions; pulse 82 to 102/min; blood pressure 124/78 to 108/70 mm Hg; dry mouth and reported thirst. The clinical team is assessing the patient.","chart":null,"options":[{"id":"A","text":"Lina is anxious; no other assessment is needed.","rationale":"The case does not establish anxiety as the explanation and leaves several findings unexplained."},{"id":"B","text":"The blood pressure value alone proves the cause.","rationale":"A single measurement does not establish the cause of the whole pattern."},{"id":"C","text":"The pattern supports a fluid-volume-deficit concern after losses and poor intake; further assessment is needed to establish severity and the plan.","rationale":"Correct. The statement links mechanism and observations while retaining uncertainty."},{"id":"D","text":"Dry mouth establishes the exact fluid replacement amount.","rationale":"A sign does not calculate a prescription."}],"correctOptionId":"C","remediation":"Build a sentence joining history, at least two different observations and one uncertainty.","sourceIds":["OR-FLUID","OR-FLUIDASSESS"],"caseFamilyId":"CASE-TEACH-LINA","exposureNote":"Worked example or a close scenario variant was presented during this lesson; use as guided practice, not fresh-family acquisition evidence.","reviewedBy":null,"reviewedAt":null},{"id":"CASE-T2","familyId":"CASE-TEACH-LINA","role":"teaching","lessonId":"w1-case","stem":"Which conclusion is justified by the new entry?","context":"Later in the same case Lina says, “My mouth feels less dry.” No repeat weight, vital signs or intake/output summary is yet available.","chart":null,"options":[{"id":"A","text":"The reported mouth symptom improved; the broader fluid concern still requires relevant reassessment.","rationale":"Correct. This preserves the value and the limit of the new report."},{"id":"B","text":"All previous abnormal findings have resolved.","rationale":"Those findings have not been reassessed in the supplied record."},{"id":"C","text":"The original concern was impossible.","rationale":"A later symptom change does not negate the earlier pattern."},{"id":"D","text":"The report is irrelevant because it is subjective.","rationale":"Patient experience is relevant assessment data when its source is identified."}],"correctOptionId":"A","remediation":"State exactly which observation changed and which observations remain unknown.","sourceIds":["OR-ASSESS","OR-FLUIDASSESS"],"caseFamilyId":"CASE-TEACH-LINA","exposureNote":"Worked example or a close scenario variant was presented during this lesson; use as guided practice, not fresh-family acquisition evidence.","reviewedBy":null,"reviewedAt":null}],"delayed":{"prompt":"On day 7, reconstruct the four-layer explanation without the case visible. After at least seven days from initial learning, use the separate unseen transfer case.","answer":"Expected layers: relevant observations; evidence-linked provisional concern; concise communication with request; further evidence that can test the concern. One correct rehearsed explanation is teaching-family retrieval, not independent transfer."},"sourceIds":["OR-ASSESS","OR-DOC","OR-FLUID","OR-FLUIDASSESS","AHRQ-SBAR","AHRQ-CHECK"],"status":"draft_needs_clinical_review"}]}