2026 NSG 3160 Exam 1|REAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS WITH RATIONALES|
ALREADY GRADED A+|LATEST 2026 VERSION!!!
The nurse caring for an older adult suspects older adult abuse. Which
action is appropriate?
a. Confront the caregivers about the suspicion of abuse.
b. Collect proof of abuse before notifying the authorities.
c. Report the abuse if the older adult gives permission.
d. Notify the authorities of the suspected older adult abuse.
d. Notify the authorities of the suspected older adult abuse.
The nurse is a mandatory reporter of older adult abuse and should notify the
authorities of suspected older adult abuse. The nurse does not need proof of
abuse before calling the authorities. The nurse should not confront the
caregivers if older adult abuse is suspected. The nurse does not need permission
from the older adult before calling the authorities.
The nurse is assessing a person who is a suspected victim of abuse.
When documenting assessment data, which of the following is the
most important concept for the nurse to remember? (Select all that
apply.)
a. Words used when documenting should be sanitized.
b. It must be detailed and unbiased.
c. Speculation on the cause of injury should be included.
d. Use the exact terms the abused person uses to describe sexual
organs.
e. Quotation marks should be used for severe threats of harm.
b, d, e
Documentation should be non-biased and include specific details, especially
when documenting signs of physical abuse. Measurements, color, and other
characteristics are important to document as specifically as possible and should
include photographic documentation. Verbatim documentation of reported
pg. 1
,perpetrator's threats can be useful in future court proceedings. Using exact terms
and asking for clarification if the nurse is unsure what the person means is
important. When quoting or paraphrasing what the abused person has said, do
not sanitize the words. The nurse should never speculate regarding the cause of
signs/symptoms. Every time the nurse documents health assessment data, he/she
must only document what they hear or assess through inspection, palpation,
percussion, and auscultation. Opinions or information not specific to assessment
findings should never be included in documentation.
A woman seeks medical attention for a cut made by a knife during a
physical assault. The health care provider would document the cut as
an
a. incision.
b. ecchymosis.
c. avulsion.
d. abrasion.
a. incision.
An incision is a cut or wound made by a sharp instrument. Ecchymosis is a
haemorrhagic spot or blotch in the skin or mucous membrane that forms a non-
elevated, rounded or regular, blue or purplish patch. An avulsion is the tearing
away of a structure or part. An abrasion is a wound caused by rubbing the skin
or mucous membrane.
To examine a toddler, the nurse should
a. allow the child to sit on the parent's lap.
b. ask the child to decide whether parents or siblings should be
present.
c. remove the child's clothing at the beginning of the examination.
d. perform the assessment from head to toes.
a. allow the child to sit on the parent's lap.
A toddler should be sitting up on the parent's lap for the examination. An infant
will not object to having clothing removed; a toddler does not like to take off his
or her clothing. A school-age child has a sense of modesty; to maintain privacy,
pg. 2
,ask a child who is 11 or 12 years old to decide whether parents or siblings
should be present. The sequence of the examination for a toddler should start
with nonthreatening areas first; save distressing procedures such as assessment
of the head, ears, nose, or throat for last.
A patient admitted to the hospital with asthma has the following
problems identified based on an admission health history and physical
assessment. Which problem is a first-level priority?
a. Ineffective self-health management
b. Impaired gas exchange
c. Readiness for enhanced spiritual well-being
d. Risk for infection
b. Impaired gas exchange
First-level priority problems are problems that are emergent, life-threatening,
and immediate. Impaired gas exchange is an emergent and immediate problem.
Third-level priority problems are problems that are important to the patient's
health but can be addressed after more urgent health problems are addressed.
Ineffective self-health management is an example of a third-level priority.
Second-level priority problems are problems that are next in urgency; these
problems require prompt intervention to forestall further deterioration. Risk for
infection is an example of a second-level priority. Third-level priority problems
are problems that are important to the patient's health but can be addressed after
more urgent health problems are addressed. Wellness diagnoses are third-level
priority problems.
Which of the following actions/behaviors in the critical-thinking
process are important for the novice nurse to remember? (Select all
that apply.)
a. Disregard initial cues
b. Approach assessment with a nonjudgmental attitude
c. Cluster associated assessment data
d. Perform assessment in whatever manner works for you.
e. Avoid making assumptions
pg. 3
, b, c, e
The nurse should never make assumptions as they may bias data collection and
selection of diagnoses. An important aspect to gain trust with the patient is to
maintain a nonjudgmental attitude. Once all health assessment data has been
collected, it is important to cluster signs and symptoms as this will help in the
critical thinking and decision-making process regarding medical and nursing
diagnoses. It also helps to categorize problems as the first, second, or third
priority.
The nurse should never disregard any cues. These are important in the
critical thinking and diagnosis decision-making process. Novice
nurses do not have enough experience to vary from the step-by-step
process for health assessment data collection. As the nurse gains
experience, he/she will learn when it's appropriate to vary the process.
An example of subjective data is
a. decreased range of motion.
b. crepitation in the left knee joint.
c. arthritis.
d. left knee has been swollen and hot for the past 3 days.
d. left knee has been swollen and hot for the past 3 days.
Subjective data is what the patient says about himself or herself during history
taking. Objective data is what the health professional observes by inspecting,
percussing, palpating, and auscultating during the physical examination. Range
of motion is assessed by inspection. Objective data is what the health
professional observes by inspecting, percussing, palpating, and auscultating
during the physical examination. Crepitation is assessed by palpating. Arthritis
is a medical diagnosis.
An example of objective data is
a. a report of impaired mobility from left knee pain as evidenced by
an inability to walk, swelling, and pain on passive range of motion.
b. a complaint of left knee pain.
c. crepitation in the left knee joint.
pg. 4
CORRECT DETAILED ANSWERS WITH RATIONALES|
ALREADY GRADED A+|LATEST 2026 VERSION!!!
The nurse caring for an older adult suspects older adult abuse. Which
action is appropriate?
a. Confront the caregivers about the suspicion of abuse.
b. Collect proof of abuse before notifying the authorities.
c. Report the abuse if the older adult gives permission.
d. Notify the authorities of the suspected older adult abuse.
d. Notify the authorities of the suspected older adult abuse.
The nurse is a mandatory reporter of older adult abuse and should notify the
authorities of suspected older adult abuse. The nurse does not need proof of
abuse before calling the authorities. The nurse should not confront the
caregivers if older adult abuse is suspected. The nurse does not need permission
from the older adult before calling the authorities.
The nurse is assessing a person who is a suspected victim of abuse.
When documenting assessment data, which of the following is the
most important concept for the nurse to remember? (Select all that
apply.)
a. Words used when documenting should be sanitized.
b. It must be detailed and unbiased.
c. Speculation on the cause of injury should be included.
d. Use the exact terms the abused person uses to describe sexual
organs.
e. Quotation marks should be used for severe threats of harm.
b, d, e
Documentation should be non-biased and include specific details, especially
when documenting signs of physical abuse. Measurements, color, and other
characteristics are important to document as specifically as possible and should
include photographic documentation. Verbatim documentation of reported
pg. 1
,perpetrator's threats can be useful in future court proceedings. Using exact terms
and asking for clarification if the nurse is unsure what the person means is
important. When quoting or paraphrasing what the abused person has said, do
not sanitize the words. The nurse should never speculate regarding the cause of
signs/symptoms. Every time the nurse documents health assessment data, he/she
must only document what they hear or assess through inspection, palpation,
percussion, and auscultation. Opinions or information not specific to assessment
findings should never be included in documentation.
A woman seeks medical attention for a cut made by a knife during a
physical assault. The health care provider would document the cut as
an
a. incision.
b. ecchymosis.
c. avulsion.
d. abrasion.
a. incision.
An incision is a cut or wound made by a sharp instrument. Ecchymosis is a
haemorrhagic spot or blotch in the skin or mucous membrane that forms a non-
elevated, rounded or regular, blue or purplish patch. An avulsion is the tearing
away of a structure or part. An abrasion is a wound caused by rubbing the skin
or mucous membrane.
To examine a toddler, the nurse should
a. allow the child to sit on the parent's lap.
b. ask the child to decide whether parents or siblings should be
present.
c. remove the child's clothing at the beginning of the examination.
d. perform the assessment from head to toes.
a. allow the child to sit on the parent's lap.
A toddler should be sitting up on the parent's lap for the examination. An infant
will not object to having clothing removed; a toddler does not like to take off his
or her clothing. A school-age child has a sense of modesty; to maintain privacy,
pg. 2
,ask a child who is 11 or 12 years old to decide whether parents or siblings
should be present. The sequence of the examination for a toddler should start
with nonthreatening areas first; save distressing procedures such as assessment
of the head, ears, nose, or throat for last.
A patient admitted to the hospital with asthma has the following
problems identified based on an admission health history and physical
assessment. Which problem is a first-level priority?
a. Ineffective self-health management
b. Impaired gas exchange
c. Readiness for enhanced spiritual well-being
d. Risk for infection
b. Impaired gas exchange
First-level priority problems are problems that are emergent, life-threatening,
and immediate. Impaired gas exchange is an emergent and immediate problem.
Third-level priority problems are problems that are important to the patient's
health but can be addressed after more urgent health problems are addressed.
Ineffective self-health management is an example of a third-level priority.
Second-level priority problems are problems that are next in urgency; these
problems require prompt intervention to forestall further deterioration. Risk for
infection is an example of a second-level priority. Third-level priority problems
are problems that are important to the patient's health but can be addressed after
more urgent health problems are addressed. Wellness diagnoses are third-level
priority problems.
Which of the following actions/behaviors in the critical-thinking
process are important for the novice nurse to remember? (Select all
that apply.)
a. Disregard initial cues
b. Approach assessment with a nonjudgmental attitude
c. Cluster associated assessment data
d. Perform assessment in whatever manner works for you.
e. Avoid making assumptions
pg. 3
, b, c, e
The nurse should never make assumptions as they may bias data collection and
selection of diagnoses. An important aspect to gain trust with the patient is to
maintain a nonjudgmental attitude. Once all health assessment data has been
collected, it is important to cluster signs and symptoms as this will help in the
critical thinking and decision-making process regarding medical and nursing
diagnoses. It also helps to categorize problems as the first, second, or third
priority.
The nurse should never disregard any cues. These are important in the
critical thinking and diagnosis decision-making process. Novice
nurses do not have enough experience to vary from the step-by-step
process for health assessment data collection. As the nurse gains
experience, he/she will learn when it's appropriate to vary the process.
An example of subjective data is
a. decreased range of motion.
b. crepitation in the left knee joint.
c. arthritis.
d. left knee has been swollen and hot for the past 3 days.
d. left knee has been swollen and hot for the past 3 days.
Subjective data is what the patient says about himself or herself during history
taking. Objective data is what the health professional observes by inspecting,
percussing, palpating, and auscultating during the physical examination. Range
of motion is assessed by inspection. Objective data is what the health
professional observes by inspecting, percussing, palpating, and auscultating
during the physical examination. Crepitation is assessed by palpating. Arthritis
is a medical diagnosis.
An example of objective data is
a. a report of impaired mobility from left knee pain as evidenced by
an inability to walk, swelling, and pain on passive range of motion.
b. a complaint of left knee pain.
c. crepitation in the left knee joint.
pg. 4
