RN Med Surg 242 Galen - Comprehensive
Exam 1 NCLEX-Style Questions with
Rationales 2026
Question 1
A nurse is caring for a patient who suddenly develops shortness of breath and chest pain. What should
the nurse do FIRST?
A. Administer oxygen via nasal cannula
B. Call the rapid response team
C. Assess the patient's vital signs and lung sounds
D. Notify the healthcare provider
ANSWER: C
Rationale:
Option A (Incorrect): While administering oxygen may be necessary, the nurse must first assess the
patient to determine the severity and cause of the symptoms. Acting without assessment violates the
ADPIE framework.
Option B (Incorrect): Calling the rapid response team may be needed, but only after initial assessment
determines the severity of the situation.
Option C (Correct): According to ADPIE, Assessment always comes first. The nurse needs to collect data
(vital signs, lung sounds, oxygen saturation) before taking action to determine the appropriate
intervention.
Option D (Incorrect): Notifying the provider is important but requires assessment data first to report
accurately.
Question 2
A patient post-operative day 1 after abdominal surgery reports severe pain rated 8/10. The patient's
vital signs are: BP 150/90, HR 110, RR 24. What is the nurse's priority action?
A. Administer the prescribed PRN pain medication
,B. Assess the surgical site and vital signs
C. Teach the patient deep breathing exercises
D. Document the pain level in the chart
ANSWER: B
Rationale:
Option A (Incorrect): While pain medication will likely be needed, the nurse must first assess to rule out
complications such as hemorrhage or infection that could be causing the elevated vital signs.
Option B (Correct): Assessment is the first step in ADPIE. The elevated vital signs could indicate
complications beyond normal post-operative pain. The nurse needs to assess the surgical site for
bleeding, infection, or other issues before intervening.
Option C (Incorrect): Teaching is important but not the priority when the patient is experiencing severe
pain and abnormal vital signs.
Option D (Incorrect): Documentation is necessary but never the priority action when a patient is
experiencing acute symptoms.
Question 3
A nurse is preparing to administer morning medications to a patient. Which action best demonstrates
patient safety?
A. Checking the medication administration record (MAR) once before the shift
B. Scanning the patient's wristband and medication barcode at bedside
C. Preparing all medications for the entire unit at once to save time
D. Asking the patient their name before entering the room
ANSWER: B
Rationale:
Option A (Incorrect): The MAR should be checked immediately before medication administration, not
just once per shift, to ensure accuracy and account for any changes.
Option B (Correct): Barcode scanning at the bedside is a critical patient safety measure that verifies the
right patient, right medication, right dose, right route, and right time. This prevents medication errors.
Option C (Incorrect): Preparing medications for multiple patients increases the risk of medication errors
and violates safety protocols.
Option D (Incorrect): While identifying the patient is important, this should be done using two identifiers
at the bedside, not before entering the room.
Question 4
,A patient with diabetes is being discharged. The nurse determines that the patient needs additional
teaching when the patient states:
A. "I will check my blood glucose before meals and at bedtime."
B. "I can skip my insulin if I'm not planning to eat."
C. "I should rotate my injection sites."
D. "I will carry hard candy in case my blood sugar drops."
ANSWER: B
Rationale:
Option A (Incorrect): This statement is correct. Monitoring blood glucose before meals and at bedtime is
appropriate for diabetes management.
Option B (Correct): This statement indicates a dangerous misconception. Patients should NOT skip
insulin without consulting their healthcare provider, even if not eating, as this can lead to hyperglycemia
and complications. This indicates need for additional teaching.
Option C (Incorrect): This statement is correct. Rotating injection sites prevents lipodystrophy and
ensures proper absorption.
Option D (Incorrect): This statement is correct. Carrying fast-acting carbohydrates is essential for
treating hypoglycemia.
Question 5
A nurse is caring for four patients. Which patient should the nurse assess FIRST?
A. A patient requesting pain medication for a pain level of 6/10
B. A patient with COPD who has an oxygen saturation of 89%
C. A patient who needs assistance with bathing
D. A patient scheduled for discharge in 2 hours
ANSWER: B
Rationale:
Option A (Incorrect): While pain management is important, a pain level of 6/10 is not immediately life-
threatening and can be addressed after more urgent needs.
Option B (Correct): Using ABCs (Airway, Breathing, Circulation) and patient safety principles, the patient
with an oxygen saturation of 89% has impaired gas exchange and requires immediate assessment and
intervention. This is the highest priority.
Option C (Incorrect): Assisting with bathing is important for hygiene and comfort but is not urgent and
can be delegated or delayed.
, Option D (Incorrect): Discharge planning is important but not urgent compared to a patient with
compromised oxygenation.
Question 6
During the evaluation phase of the nursing process, the nurse should:
A. Collect new assessment data about the patient's condition
B. Determine if the nursing interventions achieved the expected outcomes
C. Identify new nursing diagnoses based on patient responses
D. Implement additional interventions without reassessment
ANSWER: B
Rationale:
Option A (Incorrect): Collecting new assessment data is part of the Assessment phase, though
reassessment does occur during evaluation.
Option B (Correct): The Evaluate phase of ADPIE specifically involves determining whether the
interventions were effective and if the expected outcomes were achieved. This is the definition of
evaluation.
Option C (Incorrect): Identifying new nursing diagnoses is part of the Diagnose phase, though new
diagnoses may be identified based on evaluation findings.
Option D (Incorrect): Implementing interventions without reassessment violates the nursing process and
patient safety principles.
Question 7
A patient falls in the hospital bathroom. What is the nurse's FIRST action?
A. Call for help and activate the fall protocol
B. Assess the patient for injuries
C. Help the patient back to bed
D. Complete an incident report
ANSWER: B
Rationale:
Option A (Incorrect): While calling for help is important, the nurse must first assess the patient to
determine if it's safe to move them and what injuries may have occurred.
Option B (Correct): Following ADPIE, Assessment comes first. The nurse must assess the patient for
injuries, level of consciousness, and vital signs before taking any action. Moving a patient with potential
spinal or fracture injuries could cause further harm.
Exam 1 NCLEX-Style Questions with
Rationales 2026
Question 1
A nurse is caring for a patient who suddenly develops shortness of breath and chest pain. What should
the nurse do FIRST?
A. Administer oxygen via nasal cannula
B. Call the rapid response team
C. Assess the patient's vital signs and lung sounds
D. Notify the healthcare provider
ANSWER: C
Rationale:
Option A (Incorrect): While administering oxygen may be necessary, the nurse must first assess the
patient to determine the severity and cause of the symptoms. Acting without assessment violates the
ADPIE framework.
Option B (Incorrect): Calling the rapid response team may be needed, but only after initial assessment
determines the severity of the situation.
Option C (Correct): According to ADPIE, Assessment always comes first. The nurse needs to collect data
(vital signs, lung sounds, oxygen saturation) before taking action to determine the appropriate
intervention.
Option D (Incorrect): Notifying the provider is important but requires assessment data first to report
accurately.
Question 2
A patient post-operative day 1 after abdominal surgery reports severe pain rated 8/10. The patient's
vital signs are: BP 150/90, HR 110, RR 24. What is the nurse's priority action?
A. Administer the prescribed PRN pain medication
,B. Assess the surgical site and vital signs
C. Teach the patient deep breathing exercises
D. Document the pain level in the chart
ANSWER: B
Rationale:
Option A (Incorrect): While pain medication will likely be needed, the nurse must first assess to rule out
complications such as hemorrhage or infection that could be causing the elevated vital signs.
Option B (Correct): Assessment is the first step in ADPIE. The elevated vital signs could indicate
complications beyond normal post-operative pain. The nurse needs to assess the surgical site for
bleeding, infection, or other issues before intervening.
Option C (Incorrect): Teaching is important but not the priority when the patient is experiencing severe
pain and abnormal vital signs.
Option D (Incorrect): Documentation is necessary but never the priority action when a patient is
experiencing acute symptoms.
Question 3
A nurse is preparing to administer morning medications to a patient. Which action best demonstrates
patient safety?
A. Checking the medication administration record (MAR) once before the shift
B. Scanning the patient's wristband and medication barcode at bedside
C. Preparing all medications for the entire unit at once to save time
D. Asking the patient their name before entering the room
ANSWER: B
Rationale:
Option A (Incorrect): The MAR should be checked immediately before medication administration, not
just once per shift, to ensure accuracy and account for any changes.
Option B (Correct): Barcode scanning at the bedside is a critical patient safety measure that verifies the
right patient, right medication, right dose, right route, and right time. This prevents medication errors.
Option C (Incorrect): Preparing medications for multiple patients increases the risk of medication errors
and violates safety protocols.
Option D (Incorrect): While identifying the patient is important, this should be done using two identifiers
at the bedside, not before entering the room.
Question 4
,A patient with diabetes is being discharged. The nurse determines that the patient needs additional
teaching when the patient states:
A. "I will check my blood glucose before meals and at bedtime."
B. "I can skip my insulin if I'm not planning to eat."
C. "I should rotate my injection sites."
D. "I will carry hard candy in case my blood sugar drops."
ANSWER: B
Rationale:
Option A (Incorrect): This statement is correct. Monitoring blood glucose before meals and at bedtime is
appropriate for diabetes management.
Option B (Correct): This statement indicates a dangerous misconception. Patients should NOT skip
insulin without consulting their healthcare provider, even if not eating, as this can lead to hyperglycemia
and complications. This indicates need for additional teaching.
Option C (Incorrect): This statement is correct. Rotating injection sites prevents lipodystrophy and
ensures proper absorption.
Option D (Incorrect): This statement is correct. Carrying fast-acting carbohydrates is essential for
treating hypoglycemia.
Question 5
A nurse is caring for four patients. Which patient should the nurse assess FIRST?
A. A patient requesting pain medication for a pain level of 6/10
B. A patient with COPD who has an oxygen saturation of 89%
C. A patient who needs assistance with bathing
D. A patient scheduled for discharge in 2 hours
ANSWER: B
Rationale:
Option A (Incorrect): While pain management is important, a pain level of 6/10 is not immediately life-
threatening and can be addressed after more urgent needs.
Option B (Correct): Using ABCs (Airway, Breathing, Circulation) and patient safety principles, the patient
with an oxygen saturation of 89% has impaired gas exchange and requires immediate assessment and
intervention. This is the highest priority.
Option C (Incorrect): Assisting with bathing is important for hygiene and comfort but is not urgent and
can be delegated or delayed.
, Option D (Incorrect): Discharge planning is important but not urgent compared to a patient with
compromised oxygenation.
Question 6
During the evaluation phase of the nursing process, the nurse should:
A. Collect new assessment data about the patient's condition
B. Determine if the nursing interventions achieved the expected outcomes
C. Identify new nursing diagnoses based on patient responses
D. Implement additional interventions without reassessment
ANSWER: B
Rationale:
Option A (Incorrect): Collecting new assessment data is part of the Assessment phase, though
reassessment does occur during evaluation.
Option B (Correct): The Evaluate phase of ADPIE specifically involves determining whether the
interventions were effective and if the expected outcomes were achieved. This is the definition of
evaluation.
Option C (Incorrect): Identifying new nursing diagnoses is part of the Diagnose phase, though new
diagnoses may be identified based on evaluation findings.
Option D (Incorrect): Implementing interventions without reassessment violates the nursing process and
patient safety principles.
Question 7
A patient falls in the hospital bathroom. What is the nurse's FIRST action?
A. Call for help and activate the fall protocol
B. Assess the patient for injuries
C. Help the patient back to bed
D. Complete an incident report
ANSWER: B
Rationale:
Option A (Incorrect): While calling for help is important, the nurse must first assess the patient to
determine if it's safe to move them and what injuries may have occurred.
Option B (Correct): Following ADPIE, Assessment comes first. The nurse must assess the patient for
injuries, level of consciousness, and vital signs before taking any action. Moving a patient with potential
spinal or fracture injuries could cause further harm.
