NUR 254 Exam 1 | Galen College of Nursing | 2026/2027 Update 75 Questions and Answers | 100% Correct
NUR 254 EXAM 1
75 Questions and Answers | 2026/2027 Update
100% Correct • Galen College of Nursing
Total Questions: 75 Format: NCLEX-style Multiple Choice
30% Recall / 50% Application / 20% 80% Scenario-based / 20%
Cognitive Levels: Item Style:
Analysis Direct
NCSBN CJMM & 2026 NCLEX-RN Test Galen NUR 254 Course
Aligned With: Verified Against:
Plan Objectives
Instructions: Select the SINGLE best answer for each question. Rationales and test-taking strategies accompany each item to
support clinical judgment development. Use this exam to assess mastery of NUR 254 Exam 1 objectives across six NCLEX
Client Need categories: Nursing Process & Clinical Judgment; Management of Care & Safety; Health Assessment & Vital
Signs; Medication Administration & Dosage Calculation; Fluids, Electrolytes, & Acid-Base Balance; and Perioperative Care &
Diagnostic Testing.
SECTION 1 Nursing Process and Clinical Judgment (Q1-Q12)
Q1: A nurse is caring for four assigned clients. Using the nursing process, which client should the nurse assess
FIRST?
A. A client 3 days postoperative requesting pain medication for incisional discomfort rated 5/10
B. A client with chronic osteoarthritis asking for assistance to the bathroom
C. A client with sudden onset shortness of breath and audible wheezing [CORRECT]
D. A client awaiting transport to physical therapy
Correct Answer: C — C. A client with sudden onset shortness of breath and audible wheezing
Rationale: Sudden onset shortness of breath with wheezing indicates acute respiratory compromise, an immediate
Airway/Breathing priority. The other clients are stable or have expected needs that can be addressed after ABC
threats are resolved. Clinical judgment requires the nurse to recognize acute cues and act on unstable conditions
first.
Test-Taking Strategy: Apply the ABC framework and unstable-versus-stable principle. Acute respiratory distress always takes
priority.
Confidential - Educational Use Only Page 1 Verified against NUR 254 Course Materials
,NUR 254 Exam 1 | Galen College of Nursing | 2026/2027 Update 75 Questions and Answers | 100% Correct
Q2: During shift assessment, a nurse identifies a postoperative client has new onset productive cough, fever
of 101.4°F (38.6°C), and pleuritic chest pain. Which step of the nursing process is the nurse demonstrating?
A. Diagnosis
B. Assessment [CORRECT]
C. Planning
D. Implementation
Correct Answer: B — B. Assessment
Rationale: Collecting objective and subjective data (cough, fever, pain) during ongoing care is the assessment step
of ADPIE. Diagnosis would follow once the data are clustered and patterns identified. Planning requires goal-setting;
implementation requires action.
Test-Taking Strategy: New data collection = assessment. The remaining steps build on gathered cues.
Q3: A nurse is formulating a nursing diagnosis for a client with heart failure who reports increased dyspnea
with activity and has 3+ pitting edema. Which diagnosis is MOST appropriate using the PES format?
A. Activity Intolerance related to heart failure
B. Excess Fluid Volume related to compromised regulatory mechanism as evidenced by 3+ pitting edema
and dyspnea on exertion [CORRECT]
C. Risk for Impaired Gas Exchange
D. Fluid Volume Deficit
Correct Answer: B — B. Excess Fluid Volume related to compromised regulatory mechanism as evidenced by
3+ pitting edema and dyspnea on exertion
Rationale: PES format requires Problem (Excess Fluid Volume) + Etiology (compromised regulatory mechanism) +
Symptoms (edema and dyspnea). Option B includes all three elements. Options A and C are partial diagnoses;
Option D contradicts the assessment data of fluid excess.
Test-Taking Strategy: For actual diagnoses, the PES format must include problem, related-to factor, and as-evidenced-by
defining characteristics.
Q4: A nurse writes the goal: 'Client will improve mobility.' Which revision makes this goal measurable and
client-centered per the SMART criteria?
A. 'Client will ambulate in the hallway.'
B. 'Client will ambulate 100 feet in the hallway with a walker, without assistance, within 48 hours.'
[CORRECT]
C. 'Nurse will ambulate client twice daily.'
D. 'Client will be more active soon.'
Correct Answer: B — B. 'Client will ambulate 100 feet in the hallway with a walker, without assistance, within
48 hours.'
Rationale: An effective goal must be Specific, Measurable, Achievable, Relevant, and Time-bound. Option B
specifies distance, assistive device, level of independence, and timeframe. Option A is not measurable; Option C is a
nursing intervention, not a client goal; Option D is vague.
Test-Taking Strategy: Eliminate goals lacking measurable criteria (distance, frequency, level of assistance) and those written
from the nurse's perspective.
Confidential - Educational Use Only Page 2 Verified against NUR 254 Course Materials
, NUR 254 Exam 1 | Galen College of Nursing | 2026/2027 Update 75 Questions and Answers | 100% Correct
Q5: A client with type 1 diabetes has a sliding scale insulin order. The nurse administers 4 units of lispro
insulin subcutaneously before lunch. Which step of the nursing process is the nurse performing?
A. Assessment
B. Diagnosis
C. Planning
D. Implementation [CORRECT]
Correct Answer: D — D. Implementation
Rationale: Administering the prescribed insulin is the action step of implementation. Assessment gathers data;
diagnosis formulates the problem; planning establishes goals and interventions; evaluation compares outcomes to
goals. The act of carrying out an intervention is implementation.
Test-Taking Strategy: Action verb + care delivery = implementation.
Q6: A nurse evaluates the effectiveness of an intervention by comparing the client's current pain rating to
the previous rating. Which step of the nursing process is being performed?
A. Assessment
B. Diagnosis
C. Planning
D. Evaluation [CORRECT]
Correct Answer: D — D. Evaluation
Rationale: Evaluation compares current client outcomes to the established goals to determine effectiveness.
Comparing pain ratings before and after intervention is classic evaluation. Assessment collects initial data; the
remaining steps build the plan of care.
Test-Taking Strategy: Comparing findings to expected outcomes = evaluation.
Q7: A nurse receives morning report on four clients. Using Maslow's hierarchy of needs, which client need
should be addressed FIRST?
A. A client expressing feelings of loneliness
B. A client with a respiratory rate of 8 breaths/min following opioid administration [CORRECT]
C. A client requesting teaching about discharge medications
D. A client who wants to attend chapel services
Correct Answer: B — B. A client with a respiratory rate of 8 breaths/min following opioid administration
Rationale: Respiratory depression of 8 breaths/min is a physiological threat to life that must be addressed first, as it
sits at the base of Maslow's hierarchy. The nurse should administer naloxone per protocol. Psychosocial,
educational, and self-actualization needs are addressed after physiological stability.
Test-Taking Strategy: Apply Maslow: physiological needs (ABCs) first, then safety, then love/belonging, esteem,
self-actualization.
Confidential - Educational Use Only Page 3 Verified against NUR 254 Course Materials
NUR 254 EXAM 1
75 Questions and Answers | 2026/2027 Update
100% Correct • Galen College of Nursing
Total Questions: 75 Format: NCLEX-style Multiple Choice
30% Recall / 50% Application / 20% 80% Scenario-based / 20%
Cognitive Levels: Item Style:
Analysis Direct
NCSBN CJMM & 2026 NCLEX-RN Test Galen NUR 254 Course
Aligned With: Verified Against:
Plan Objectives
Instructions: Select the SINGLE best answer for each question. Rationales and test-taking strategies accompany each item to
support clinical judgment development. Use this exam to assess mastery of NUR 254 Exam 1 objectives across six NCLEX
Client Need categories: Nursing Process & Clinical Judgment; Management of Care & Safety; Health Assessment & Vital
Signs; Medication Administration & Dosage Calculation; Fluids, Electrolytes, & Acid-Base Balance; and Perioperative Care &
Diagnostic Testing.
SECTION 1 Nursing Process and Clinical Judgment (Q1-Q12)
Q1: A nurse is caring for four assigned clients. Using the nursing process, which client should the nurse assess
FIRST?
A. A client 3 days postoperative requesting pain medication for incisional discomfort rated 5/10
B. A client with chronic osteoarthritis asking for assistance to the bathroom
C. A client with sudden onset shortness of breath and audible wheezing [CORRECT]
D. A client awaiting transport to physical therapy
Correct Answer: C — C. A client with sudden onset shortness of breath and audible wheezing
Rationale: Sudden onset shortness of breath with wheezing indicates acute respiratory compromise, an immediate
Airway/Breathing priority. The other clients are stable or have expected needs that can be addressed after ABC
threats are resolved. Clinical judgment requires the nurse to recognize acute cues and act on unstable conditions
first.
Test-Taking Strategy: Apply the ABC framework and unstable-versus-stable principle. Acute respiratory distress always takes
priority.
Confidential - Educational Use Only Page 1 Verified against NUR 254 Course Materials
,NUR 254 Exam 1 | Galen College of Nursing | 2026/2027 Update 75 Questions and Answers | 100% Correct
Q2: During shift assessment, a nurse identifies a postoperative client has new onset productive cough, fever
of 101.4°F (38.6°C), and pleuritic chest pain. Which step of the nursing process is the nurse demonstrating?
A. Diagnosis
B. Assessment [CORRECT]
C. Planning
D. Implementation
Correct Answer: B — B. Assessment
Rationale: Collecting objective and subjective data (cough, fever, pain) during ongoing care is the assessment step
of ADPIE. Diagnosis would follow once the data are clustered and patterns identified. Planning requires goal-setting;
implementation requires action.
Test-Taking Strategy: New data collection = assessment. The remaining steps build on gathered cues.
Q3: A nurse is formulating a nursing diagnosis for a client with heart failure who reports increased dyspnea
with activity and has 3+ pitting edema. Which diagnosis is MOST appropriate using the PES format?
A. Activity Intolerance related to heart failure
B. Excess Fluid Volume related to compromised regulatory mechanism as evidenced by 3+ pitting edema
and dyspnea on exertion [CORRECT]
C. Risk for Impaired Gas Exchange
D. Fluid Volume Deficit
Correct Answer: B — B. Excess Fluid Volume related to compromised regulatory mechanism as evidenced by
3+ pitting edema and dyspnea on exertion
Rationale: PES format requires Problem (Excess Fluid Volume) + Etiology (compromised regulatory mechanism) +
Symptoms (edema and dyspnea). Option B includes all three elements. Options A and C are partial diagnoses;
Option D contradicts the assessment data of fluid excess.
Test-Taking Strategy: For actual diagnoses, the PES format must include problem, related-to factor, and as-evidenced-by
defining characteristics.
Q4: A nurse writes the goal: 'Client will improve mobility.' Which revision makes this goal measurable and
client-centered per the SMART criteria?
A. 'Client will ambulate in the hallway.'
B. 'Client will ambulate 100 feet in the hallway with a walker, without assistance, within 48 hours.'
[CORRECT]
C. 'Nurse will ambulate client twice daily.'
D. 'Client will be more active soon.'
Correct Answer: B — B. 'Client will ambulate 100 feet in the hallway with a walker, without assistance, within
48 hours.'
Rationale: An effective goal must be Specific, Measurable, Achievable, Relevant, and Time-bound. Option B
specifies distance, assistive device, level of independence, and timeframe. Option A is not measurable; Option C is a
nursing intervention, not a client goal; Option D is vague.
Test-Taking Strategy: Eliminate goals lacking measurable criteria (distance, frequency, level of assistance) and those written
from the nurse's perspective.
Confidential - Educational Use Only Page 2 Verified against NUR 254 Course Materials
, NUR 254 Exam 1 | Galen College of Nursing | 2026/2027 Update 75 Questions and Answers | 100% Correct
Q5: A client with type 1 diabetes has a sliding scale insulin order. The nurse administers 4 units of lispro
insulin subcutaneously before lunch. Which step of the nursing process is the nurse performing?
A. Assessment
B. Diagnosis
C. Planning
D. Implementation [CORRECT]
Correct Answer: D — D. Implementation
Rationale: Administering the prescribed insulin is the action step of implementation. Assessment gathers data;
diagnosis formulates the problem; planning establishes goals and interventions; evaluation compares outcomes to
goals. The act of carrying out an intervention is implementation.
Test-Taking Strategy: Action verb + care delivery = implementation.
Q6: A nurse evaluates the effectiveness of an intervention by comparing the client's current pain rating to
the previous rating. Which step of the nursing process is being performed?
A. Assessment
B. Diagnosis
C. Planning
D. Evaluation [CORRECT]
Correct Answer: D — D. Evaluation
Rationale: Evaluation compares current client outcomes to the established goals to determine effectiveness.
Comparing pain ratings before and after intervention is classic evaluation. Assessment collects initial data; the
remaining steps build the plan of care.
Test-Taking Strategy: Comparing findings to expected outcomes = evaluation.
Q7: A nurse receives morning report on four clients. Using Maslow's hierarchy of needs, which client need
should be addressed FIRST?
A. A client expressing feelings of loneliness
B. A client with a respiratory rate of 8 breaths/min following opioid administration [CORRECT]
C. A client requesting teaching about discharge medications
D. A client who wants to attend chapel services
Correct Answer: B — B. A client with a respiratory rate of 8 breaths/min following opioid administration
Rationale: Respiratory depression of 8 breaths/min is a physiological threat to life that must be addressed first, as it
sits at the base of Maslow's hierarchy. The nurse should administer naloxone per protocol. Psychosocial,
educational, and self-actualization needs are addressed after physiological stability.
Test-Taking Strategy: Apply Maslow: physiological needs (ABCs) first, then safety, then love/belonging, esteem,
self-actualization.
Confidential - Educational Use Only Page 3 Verified against NUR 254 Course Materials
