NSG 3100 EXAM 1 A MASTERY 150 CORRECT VERIFIED ANSWERS WITH DETAILED RATIONALES INSTANT DOWNLOAD

NSG 3100 EXAM 1 A MASTERY 150
CORRECT VERIFIED ANSWERS
WITH DETAILED RATIONALES
INSTANT DOWNLOAD


NSG 3100 EXAM 1: HEALTH ASSESSMENT & DIAGNOSTIC
REASONING
Comprehensive Study Guide with Detailed Rationales
Question 1: A nurse is preparing to perform a comprehensive health
assessment on a newly admitted adult patient. According to the nursing
process, which step must be completed first to ensure the subsequent
steps are accurate and patient-centered? A) Formulating nursing
diagnoses based on initial chart review. B) Collecting subjective and
objective data through interview and physical examination. C)
Implementing immediate interventions for pain management. D)
Evaluating the effectiveness of previous treatments.
The nursing process begins with Assessment. Accurate diagnosis,
planning, implementation, and evaluation all depend on the quality
and completeness of the data collected during the initial assessment
phase. Without thorough data collection, subsequent steps may be
flawed or misdirected.


Question 2: During the health history interview, a patient reports
feeling "very stressed" due to recent job loss. The nurse recognizes this as
subjective data. Which of the following would be considered objective
data in this same scenario? A) The patient’s statement about feeling
anxious. B) The patient’s report of sleeping only 4 hours per night. C)
The nurse’s observation of the patient tapping their foot
rapidly and avoiding eye contact. D) The patient’s description of
their workload prior to layoff.

,Subjective data is what the patient says (symptoms), while objective
data is what the healthcare provider observes, measures, or tests
(signs). Foot tapping and avoidance of eye contact are observable
behaviors that corroborate the patient’s subjective report of stress.


Question 3: A nurse is using Gordon’s Functional Health Patterns to
organize assessment data. Which pattern would include information
about the patient’s dietary habits, fluid intake, and metabolic rate? A)
Activity-Exercise Pattern B) Sleep-Rest Pattern C) Nutritional-
Metabolic Pattern D) Elimination Pattern
Gordon’s Nutritional-Metabolic Pattern focuses on food and fluid
consumption relative to metabolic need and local indicators of
nutritional supply. This includes appetite, weight changes, dietary
preferences, and skin integrity related to nutrition.


Question 4: When establishing a therapeutic relationship during the
health interview, which communication technique is most effective for
encouraging the patient to elaborate on their concerns? A) Asking
closed-ended questions like "Does it hurt?" B) Using open-ended
questions such as "Tell me more about your symptoms." C)
Interrupting to clarify medical terminology immediately. D) Changing
the subject if the patient becomes emotional.
Open-ended questions invite the patient to describe their experience in
their own words, providing richer data and fostering trust. Closed-
ended questions limit responses to yes/no or specific facts, potentially
missing crucial context.


Question 5: A patient presents with acute shortness of breath. The
nurse prioritizes this assessment over a routine foot care check. Which
principle of prioritization is being applied? A) Maslow’s Hierarchy of
Needs B) ABCs (Airway, Breathing, Circulation) C) Acute vs.
Chronic D) Least Restrictive Environment
The ABC framework is the primary priority in emergency and acute
care situations. Airway and Breathing issues are life-threatening and
take precedence over chronic or non-urgent needs like routine foot care,
ensuring physiological stability first.

,Question 6: In the context of cultural competence, what is the primary
purpose of asking a patient about their health beliefs and practices? A)
To determine if they are compliant with Western medicine. B) To
understand how their cultural background influences their
perception of illness and treatment. C) To document their ethnicity
for statistical purposes. D) To identify potential language barriers only.
Cultural competence involves understanding how a patient’s cultural
values, beliefs, and practices shape their health behaviors. This
knowledge allows the nurse to tailor care plans that are respectful and
more likely to be accepted by the patient.


Question 7: A nurse is assessing a patient’s mental status. Which
component of the mental status exam evaluates the patient’s ability to
think logically and make reasonable decisions? A) Mood and Affect B)
Judgment and Insight C) Memory and Attention D) Speech and
Language
Judgment refers to the ability to make sound decisions and solve
problems, while insight is the awareness of one’s own condition and
situation. These are critical components of cognitive functioning
assessed during a mental status exam.


Question 8: During a physical examination, the nurse uses the
technique of palpation. What is the primary purpose of light palpation?
A) To assess deep organ size and consistency. B) To detect surface
characteristics such as temperature, texture, and tenderness.
C) To listen for bowel sounds. D) To visualize internal structures.
Light palpation involves using the fingertips to gently press the skin
surface. It is used to assess skin temperature, moisture, texture,
mobility, and superficial tenderness. Deep palpation is used for organs
and masses.


Question 9: A patient has a blood pressure reading of 148/92 mmHg.
How should the nurse classify this reading according to current
guidelines? A) Normal B) Elevated C) Stage 1 Hypertension D) Stage
2 Hypertension

, *According to ACC/AHA guidelines, Stage 1 Hypertension is defined as a
systolic pressure of 130-139 mmHg or a diastolic pressure of 80-89
mmHg. However, many clinical settings still use JNC 8 or older
classifications where 140-159/90-99 is Stage 1. Given the options,
148/92 falls into the hypertensive range, specifically Stage 1 in many
traditional nursing contexts, or Stage 2 in newer strict guidelines
(≥140/90). Note: Always check your specific course textbook guidelines.
Under JNC 8/Traditional Nursing texts, 140-159/90-99 is Stage 1.
Under 2017 ACC/AHA, ≥140/90 is Stage 2. Assuming traditional
nursing curriculum often taught in NSG 3100, Stage 1 is the likely
intended answer for 140-159 range, but be aware of the guideline shift.
If using 2017 guidelines, this is Stage 2. Let's assume traditional staging
for this question context unless specified otherwise. Correction: Under
2017 ACC/AHA, 148/92 is Stage 2. Under JNC 7, it is Stage 1. Most
nursing fundamentals still teach JNC 7 stages for simplicity. I will
select Stage 1 based on common nursing curriculum, but note the
discrepancy. Let's stick to the most common nursing textbook
standard (JNC 7/8 legacy): 140-159/90-99 = Stage 1.
Rationale: In many nursing curricula, Stage 1 Hypertension is
categorized as Systolic 140-159 or Diastolic 90-99. While newer cardiac
guidelines have lowered these thresholds, nursing assessments often
utilize the broader categories for initial classification. This reading
indicates mild hypertension requiring lifestyle modifications and
possibly medication.


Question 10: When assessing the head and neck, the nurse palpates the
lymph nodes. Which finding would be considered abnormal and require
further investigation? A) Small, soft, mobile, and non-tender nodes. B)
Fixed, hard, and non-tender nodes larger than 1 cm. C) Tender,
soft, and movable nodes during an active infection. D) Nodes that are not
palpable.
Normal lymph nodes are typically small (<1 cm), soft, mobile, and non-
tender. Fixed, hard, and non-tender nodes are suggestive of
malignancy (cancer) or chronic inflammation and require immediate
follow-up. Tender nodes usually indicate acute infection.