GALEN COLLEGE OF NURSING
Course Code: NSG 3000
Instructor:
Date: 2026
FINAL EXAM – FOUNDATIONS OF PROFESSIONAL
NURSING PRACTICE
1. A postoperative patient develops sudden shortness of breath and pleuritic
chest pain. Which immediate nursing action is highest priority?
A. Administer PRN analgesic
B. Obtain a chest x‑ray
C. Assess airway, breathing, and oxygen saturation; apply supplemental
oxygen and call for rapid response
D. Document the event and continue routine monitoring
Answer: C
Rationale: Airway and breathing are immediate priorities; hypoxemia
requires prompt oxygenation and escalation for suspected pulmonary
embolism or other acute events.
2. During medication administration, a nurse notes a discrepancy between
the MAR and the physician’s order. What is the correct next step?
A. Administer medication per MAR to avoid delay
B. Hold the medication and clarify the order with the prescriber before
administration
C. Ask a colleague to decide
D. Document the discrepancy and proceed
Answer: B
Rationale: Clarifying prevents medication errors; holding until verified
protects patient safety and meets legal/ethical obligations.
3. A patient with diabetes is scheduled for surgery in the morning. Which
1
,preoperative nursing intervention best reduces risk of perioperative
hyperglycemia?
A. Withhold all insulin the night before
B. Give full morning dose of long‑acting insulin without adjustment
C. Coordinate with anesthesia/physician to adjust insulin regimen and
monitor blood glucose preoperatively
D. Encourage high‑carbohydrate snack before fasting
Answer: C
Rationale: Individualized insulin adjustments and glucose monitoring
reduce perioperative glycemic excursions and complications.
4. Which element of the nursing process is demonstrated when a nurse uses
standardized scales to prioritize patient problems?
A. Implementation only
B. Assessment and diagnosis (clinical judgment)
C. Evaluation only
D. Documentation only
Answer: B
Rationale: Using validated assessment tools informs clinical judgment and
problem identification, foundational to planning care.
5. A patient refuses a blood transfusion for religious reasons. The nurse’s
best response is to:
A. Force the transfusion for safety
B. Respect the refusal, document it, notify the provider, and explore
alternatives and advance directives
C. Ignore the refusal and proceed with other treatments
D. Discharge the patient immediately
Answer: B
Rationale: Respect for autonomy requires honoring informed refusals,
documenting, and coordinating alternative care while ensuring patient
understanding.
6. Which delegation is appropriate for an RN to assign to an experienced
LPN/LVN?
A. Initiate a blood transfusion independently
B. Administer a stable patient’s routine oral medications and perform
wound dressing per protocol
C. Develop the initial nursing care plan for a newly admitted unstable
patient
D. Perform initial comprehensive admission assessment
Answer: B
Rationale: Delegation must match scope of practice and patient stability;
2
, LPNs can administer routine meds and perform delegated procedures under
supervision.
7. A nurse suspects elder abuse during a home visit. The nurse should first:
A. Confront the suspected abuser aggressively
B. Ensure patient safety, document findings objectively, and report to
appropriate protective services per law and facility policy
C. Ignore to preserve family privacy
D. Remove the patient from home without consent
Answer: B
Rationale: Mandatory reporting and objective documentation protect
vulnerable adults while following legal and ethical obligations.
8. Which communication technique most effectively reduces medication
errors during handoff?
A. Informal hallway conversation
B. Structured bedside handoff using SBAR and read‑back for critical items
C. Leaving a voicemail for the next nurse
D. Email summary at end of shift only
Answer: B
Rationale: Structured, face‑to‑face handoffs with read‑back ensure
accurate transfer of critical information and reduce errors.
9. A patient with chronic heart failure gains 4 kg in 3 days and reports
increased dyspnea. The nurse recognizes this as:
A. Normal variation
B. Sign of fluid overload and possible decompensation requiring immediate
intervention
C. Weight gain due to muscle mass
D. A reason to decrease diuretics without consulting provider
Answer: B
Rationale: Rapid weight gain indicates fluid retention; prompt assessment
and treatment adjustments are necessary to prevent pulmonary edema.
10. Which ethical principle is most directly involved when a nurse honors a
patient’s advance directive refusing life‑sustaining treatment?
A. Beneficence only
B. Nonmaleficence only
C. Autonomy
D. Justice only
Answer: C
Rationale: Respecting advance directives upholds patient autonomy and
self‑determination regarding medical decisions.
3
Course Code: NSG 3000
Instructor:
Date: 2026
FINAL EXAM – FOUNDATIONS OF PROFESSIONAL
NURSING PRACTICE
1. A postoperative patient develops sudden shortness of breath and pleuritic
chest pain. Which immediate nursing action is highest priority?
A. Administer PRN analgesic
B. Obtain a chest x‑ray
C. Assess airway, breathing, and oxygen saturation; apply supplemental
oxygen and call for rapid response
D. Document the event and continue routine monitoring
Answer: C
Rationale: Airway and breathing are immediate priorities; hypoxemia
requires prompt oxygenation and escalation for suspected pulmonary
embolism or other acute events.
2. During medication administration, a nurse notes a discrepancy between
the MAR and the physician’s order. What is the correct next step?
A. Administer medication per MAR to avoid delay
B. Hold the medication and clarify the order with the prescriber before
administration
C. Ask a colleague to decide
D. Document the discrepancy and proceed
Answer: B
Rationale: Clarifying prevents medication errors; holding until verified
protects patient safety and meets legal/ethical obligations.
3. A patient with diabetes is scheduled for surgery in the morning. Which
1
,preoperative nursing intervention best reduces risk of perioperative
hyperglycemia?
A. Withhold all insulin the night before
B. Give full morning dose of long‑acting insulin without adjustment
C. Coordinate with anesthesia/physician to adjust insulin regimen and
monitor blood glucose preoperatively
D. Encourage high‑carbohydrate snack before fasting
Answer: C
Rationale: Individualized insulin adjustments and glucose monitoring
reduce perioperative glycemic excursions and complications.
4. Which element of the nursing process is demonstrated when a nurse uses
standardized scales to prioritize patient problems?
A. Implementation only
B. Assessment and diagnosis (clinical judgment)
C. Evaluation only
D. Documentation only
Answer: B
Rationale: Using validated assessment tools informs clinical judgment and
problem identification, foundational to planning care.
5. A patient refuses a blood transfusion for religious reasons. The nurse’s
best response is to:
A. Force the transfusion for safety
B. Respect the refusal, document it, notify the provider, and explore
alternatives and advance directives
C. Ignore the refusal and proceed with other treatments
D. Discharge the patient immediately
Answer: B
Rationale: Respect for autonomy requires honoring informed refusals,
documenting, and coordinating alternative care while ensuring patient
understanding.
6. Which delegation is appropriate for an RN to assign to an experienced
LPN/LVN?
A. Initiate a blood transfusion independently
B. Administer a stable patient’s routine oral medications and perform
wound dressing per protocol
C. Develop the initial nursing care plan for a newly admitted unstable
patient
D. Perform initial comprehensive admission assessment
Answer: B
Rationale: Delegation must match scope of practice and patient stability;
2
, LPNs can administer routine meds and perform delegated procedures under
supervision.
7. A nurse suspects elder abuse during a home visit. The nurse should first:
A. Confront the suspected abuser aggressively
B. Ensure patient safety, document findings objectively, and report to
appropriate protective services per law and facility policy
C. Ignore to preserve family privacy
D. Remove the patient from home without consent
Answer: B
Rationale: Mandatory reporting and objective documentation protect
vulnerable adults while following legal and ethical obligations.
8. Which communication technique most effectively reduces medication
errors during handoff?
A. Informal hallway conversation
B. Structured bedside handoff using SBAR and read‑back for critical items
C. Leaving a voicemail for the next nurse
D. Email summary at end of shift only
Answer: B
Rationale: Structured, face‑to‑face handoffs with read‑back ensure
accurate transfer of critical information and reduce errors.
9. A patient with chronic heart failure gains 4 kg in 3 days and reports
increased dyspnea. The nurse recognizes this as:
A. Normal variation
B. Sign of fluid overload and possible decompensation requiring immediate
intervention
C. Weight gain due to muscle mass
D. A reason to decrease diuretics without consulting provider
Answer: B
Rationale: Rapid weight gain indicates fluid retention; prompt assessment
and treatment adjustments are necessary to prevent pulmonary edema.
10. Which ethical principle is most directly involved when a nurse honors a
patient’s advance directive refusing life‑sustaining treatment?
A. Beneficence only
B. Nonmaleficence only
C. Autonomy
D. Justice only
Answer: C
Rationale: Respecting advance directives upholds patient autonomy and
self‑determination regarding medical decisions.
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