NSG 3100 Exams 1, 2 & 3 - Nursing Practice - Actual Questions
& Answers (Updated PDF) - Galen College of Nursing - 240
Questions
This exam assesses foundational nursing knowledge, including the nursing process, evidence-based practice,
safety, infection control, communication, and ethical-legal principles. Questions require application of concepts
to clinical scenarios, analysis of data, and synthesis of best practices. It contains 240 multiple-choice questions,
each with four distractors and a fully worked rationale that explains why the keyed answer is correct. Content is
organized into 12 focused sections: Fundamentals of Nursing Practice, Health Assessment and Vital Signs,
Infection Control and Safety, Pharmacology and Medication Administration, Perioperative Nursing Care, Fluid,
Electrolyte, and Acid-Base Balance, Oxygenation and Respiratory Care, Cardiovascular and Circulatory Support,
Nutrition and Elimination, Pain Management and Comfort, Psychosocial and Cultural Considerations, Legal and
Ethical Issues in Nursing. Targeted learning outcomes include: Apply the nursing process to patient care;
Demonstrate understanding of infection prevention and safety; Analyze ethical and legal dimensions of nursing
practice; Integrate evidence-based practice in clinical decision-making. Every item has been reviewed for clinical
accuracy, current guidelines, and clarity so that students can study with confidence and self-correct as they work
through the bank. Use it as a high-yield review immediately before the exam, or as a structured practice tool
during the unit - the rationales double as concise teaching notes. The recommended writing time is 3 hours, with a
passing score of 78%. Aligned with This exam aligns with the AACN Essentials of Baccalaureate Education for
Section 1: Fundamentals of Nursing Practice (Questions 1-21)
1 A nurse is assessing a patient who has a history of chronic kidney disease
and is receiving intravenous fluids. Which finding is most indicative of fluid
volume excess?
A) Decreased central venous pressure
B) Increased hematocrit
C) Increased serum osmolality
D) Bounding peripheral pulses
Answer: D
Rationale: Bounding pulses are a classic sign of fluid volume excess due to
increased stroke volume. Decreased CVP indicates hypovolemia. Increased
hematocrit and serum osmolality suggest hemoconcentration from fluid deficit.
2 Which action by a novice nurse indicates a correct understanding of sterile
technique when changing a surgical wound dressing?
A) Holding the sterile forceps below waist level to avoid contamination
B) Placing the sterile drape on the over-bed table with the non-sterile package
first
C) Opening the outer wrapper of a sterile item toward the body
D) Pouring sterile solution onto a sterile field from a height of 6 inches
,Answer: D
Rationale: Pouring from 6 inches minimizes splash and maintains sterility.
Holding items below waist level contaminates them. The sterile drape should
be placed with the sterile side facing up, and the outer wrapper should be
opened away from the body to prevent contamination.
3 A patient refuses a prescribed blood transfusion based on religious beliefs.
The nurse respects this decision. Which ethical principle is the nurse
primarily demonstrating?
A) Beneficence
B) Nonmaleficence
C) Autonomy
D) Justice
Answer: C
Rationale: Autonomy recognizes the patient's right to make decisions about
their own healthcare. Beneficence would involve doing good, nonmaleficence
is avoiding harm, and justice is fairness. The nurse upholds autonomy by
respecting the refusal.
4 A nurse is providing discharge teaching to a patient with a new prescription
for enoxaparin. Which statement by the patient indicates a need for further
teaching?
A) I will inject the medication into my abdomen.
B) I should not rub the injection site after administration.
C) I can take aspirin for headaches if needed.
D) I will rotate injection sites between left and right sides.
Answer: C
Rationale: Aspirin increases bleeding risk and should be avoided with
enoxaparin. The other statements are correct: subcutaneous injection in the
abdomen, no rubbing to prevent bruising, and site rotation are appropriate.
5 A nurse is preparing to administer a blood transfusion. Which action is most
important to prevent a transfusion reaction?
A) Verify the patient's identity using two identifiers
B) Use a 22-gauge IV catheter for the transfusion
C) Start the transfusion slowly at 20 mL/min
,D) Prime the blood tubing with normal saline containing dextrose
Answer: A
Rationale: Proper identification prevents ABO incompatibility reactions.
Catheter size should be at least 20-gauge for blood. Initial rate is slow (2
mL/min) for first 15 minutes. Dextrose solutions can cause hemolysis and
should not be used with blood.
6 A nurse is assessing a patient who has a nasogastric tube connected to
intermittent suction. Which finding requires immediate intervention?
A) Gastric pH of 4
B) Absent bowel sounds
C) Serum sodium level of 136 mEq/L
D) Greenish-brown drainage
Answer: B
Rationale: Absent bowel sounds may indicate paralytic ileus, which can lead to
distention and perforation. Gastric pH 4 is normal. Sodium 136 is normal.
Greenish-brown drainage is typical for gastric contents.
7 A patient with a stage 3 pressure injury on the sacrum has a wound culture
positive for methicillin-resistant Staphylococcus aureus. Which isolation
precaution should the nurse implement?
A) Contact precautions
B) Droplet precautions
C) Airborne precautions
D) Protective environment
Answer: A
Rationale: MRSA requires contact precautions because it is transmitted via
direct or indirect contact. Droplet precautions are for respiratory droplets,
airborne for small particles, and protective environment for
immunocompromised patients.
8 A nurse is evaluating a patient's understanding of a low-sodium diet. Which
meal selection indicates the patient understands the teaching?
A) Grilled chicken with steamed vegetables and a side of apple slices
B) Ham and cheese sandwich with potato chips
C) Canned tomato soup with saltine crackers
, D) Fried fish with french fries and coleslaw
Answer: A
Rationale: Grilled chicken, steamed vegetables, and apple slices are naturally
low in sodium. Ham, cheese, canned soup, crackers, fried fish, and fries are
high in sodium due to processing and added salt.
9 A nurse is caring for a patient who is receiving a continuous intravenous
infusion of heparin. The aPTT is 90 seconds. The nurse should anticipate
which prescription?
A) Increase the heparin infusion rate
B) Decrease the heparin infusion rate
C) Administer protamine sulfate
D) Continue the current infusion rate
Answer: B
Rationale: Therapeutic aPTT for heparin is typically 1.5-2.5 times the control
(usually 30-40 seconds), so 90 seconds is above therapeutic range, indicating
increased bleeding risk. The infusion should be decreased. Protamine is for
reversal of heparin, not for adjustment.
10 A nurse is assessing a patient who has just undergone a lumbar puncture.
Which finding is most concerning?
A) Complaint of headache when sitting up
B) Clear fluid leaking from the puncture site
C) Mild discomfort at the puncture site
D) Temperature of 37.2°C (99°F)
Answer: B
Rationale: Clear fluid may be cerebrospinal fluid, indicating a dural leak, which
can lead to infection or low-pressure headache. Headache is common
post-lumbar puncture but not as concerning. Mild discomfort is expected.
Temperature 37.2°C is normal.
11 A nurse is evaluating a patient's arterial blood gas results: pH 7.25, PaCO2
60 mm Hg, HCO3- 24 mEq/L. Which acid-base imbalance is present, and
what is the primary compensatory mechanism?
A) Respiratory acidosis; renal retention of bicarbonate
B) Respiratory alkalosis; renal excretion of bicarbonate
& Answers (Updated PDF) - Galen College of Nursing - 240
Questions
This exam assesses foundational nursing knowledge, including the nursing process, evidence-based practice,
safety, infection control, communication, and ethical-legal principles. Questions require application of concepts
to clinical scenarios, analysis of data, and synthesis of best practices. It contains 240 multiple-choice questions,
each with four distractors and a fully worked rationale that explains why the keyed answer is correct. Content is
organized into 12 focused sections: Fundamentals of Nursing Practice, Health Assessment and Vital Signs,
Infection Control and Safety, Pharmacology and Medication Administration, Perioperative Nursing Care, Fluid,
Electrolyte, and Acid-Base Balance, Oxygenation and Respiratory Care, Cardiovascular and Circulatory Support,
Nutrition and Elimination, Pain Management and Comfort, Psychosocial and Cultural Considerations, Legal and
Ethical Issues in Nursing. Targeted learning outcomes include: Apply the nursing process to patient care;
Demonstrate understanding of infection prevention and safety; Analyze ethical and legal dimensions of nursing
practice; Integrate evidence-based practice in clinical decision-making. Every item has been reviewed for clinical
accuracy, current guidelines, and clarity so that students can study with confidence and self-correct as they work
through the bank. Use it as a high-yield review immediately before the exam, or as a structured practice tool
during the unit - the rationales double as concise teaching notes. The recommended writing time is 3 hours, with a
passing score of 78%. Aligned with This exam aligns with the AACN Essentials of Baccalaureate Education for
Section 1: Fundamentals of Nursing Practice (Questions 1-21)
1 A nurse is assessing a patient who has a history of chronic kidney disease
and is receiving intravenous fluids. Which finding is most indicative of fluid
volume excess?
A) Decreased central venous pressure
B) Increased hematocrit
C) Increased serum osmolality
D) Bounding peripheral pulses
Answer: D
Rationale: Bounding pulses are a classic sign of fluid volume excess due to
increased stroke volume. Decreased CVP indicates hypovolemia. Increased
hematocrit and serum osmolality suggest hemoconcentration from fluid deficit.
2 Which action by a novice nurse indicates a correct understanding of sterile
technique when changing a surgical wound dressing?
A) Holding the sterile forceps below waist level to avoid contamination
B) Placing the sterile drape on the over-bed table with the non-sterile package
first
C) Opening the outer wrapper of a sterile item toward the body
D) Pouring sterile solution onto a sterile field from a height of 6 inches
,Answer: D
Rationale: Pouring from 6 inches minimizes splash and maintains sterility.
Holding items below waist level contaminates them. The sterile drape should
be placed with the sterile side facing up, and the outer wrapper should be
opened away from the body to prevent contamination.
3 A patient refuses a prescribed blood transfusion based on religious beliefs.
The nurse respects this decision. Which ethical principle is the nurse
primarily demonstrating?
A) Beneficence
B) Nonmaleficence
C) Autonomy
D) Justice
Answer: C
Rationale: Autonomy recognizes the patient's right to make decisions about
their own healthcare. Beneficence would involve doing good, nonmaleficence
is avoiding harm, and justice is fairness. The nurse upholds autonomy by
respecting the refusal.
4 A nurse is providing discharge teaching to a patient with a new prescription
for enoxaparin. Which statement by the patient indicates a need for further
teaching?
A) I will inject the medication into my abdomen.
B) I should not rub the injection site after administration.
C) I can take aspirin for headaches if needed.
D) I will rotate injection sites between left and right sides.
Answer: C
Rationale: Aspirin increases bleeding risk and should be avoided with
enoxaparin. The other statements are correct: subcutaneous injection in the
abdomen, no rubbing to prevent bruising, and site rotation are appropriate.
5 A nurse is preparing to administer a blood transfusion. Which action is most
important to prevent a transfusion reaction?
A) Verify the patient's identity using two identifiers
B) Use a 22-gauge IV catheter for the transfusion
C) Start the transfusion slowly at 20 mL/min
,D) Prime the blood tubing with normal saline containing dextrose
Answer: A
Rationale: Proper identification prevents ABO incompatibility reactions.
Catheter size should be at least 20-gauge for blood. Initial rate is slow (2
mL/min) for first 15 minutes. Dextrose solutions can cause hemolysis and
should not be used with blood.
6 A nurse is assessing a patient who has a nasogastric tube connected to
intermittent suction. Which finding requires immediate intervention?
A) Gastric pH of 4
B) Absent bowel sounds
C) Serum sodium level of 136 mEq/L
D) Greenish-brown drainage
Answer: B
Rationale: Absent bowel sounds may indicate paralytic ileus, which can lead to
distention and perforation. Gastric pH 4 is normal. Sodium 136 is normal.
Greenish-brown drainage is typical for gastric contents.
7 A patient with a stage 3 pressure injury on the sacrum has a wound culture
positive for methicillin-resistant Staphylococcus aureus. Which isolation
precaution should the nurse implement?
A) Contact precautions
B) Droplet precautions
C) Airborne precautions
D) Protective environment
Answer: A
Rationale: MRSA requires contact precautions because it is transmitted via
direct or indirect contact. Droplet precautions are for respiratory droplets,
airborne for small particles, and protective environment for
immunocompromised patients.
8 A nurse is evaluating a patient's understanding of a low-sodium diet. Which
meal selection indicates the patient understands the teaching?
A) Grilled chicken with steamed vegetables and a side of apple slices
B) Ham and cheese sandwich with potato chips
C) Canned tomato soup with saltine crackers
, D) Fried fish with french fries and coleslaw
Answer: A
Rationale: Grilled chicken, steamed vegetables, and apple slices are naturally
low in sodium. Ham, cheese, canned soup, crackers, fried fish, and fries are
high in sodium due to processing and added salt.
9 A nurse is caring for a patient who is receiving a continuous intravenous
infusion of heparin. The aPTT is 90 seconds. The nurse should anticipate
which prescription?
A) Increase the heparin infusion rate
B) Decrease the heparin infusion rate
C) Administer protamine sulfate
D) Continue the current infusion rate
Answer: B
Rationale: Therapeutic aPTT for heparin is typically 1.5-2.5 times the control
(usually 30-40 seconds), so 90 seconds is above therapeutic range, indicating
increased bleeding risk. The infusion should be decreased. Protamine is for
reversal of heparin, not for adjustment.
10 A nurse is assessing a patient who has just undergone a lumbar puncture.
Which finding is most concerning?
A) Complaint of headache when sitting up
B) Clear fluid leaking from the puncture site
C) Mild discomfort at the puncture site
D) Temperature of 37.2°C (99°F)
Answer: B
Rationale: Clear fluid may be cerebrospinal fluid, indicating a dural leak, which
can lead to infection or low-pressure headache. Headache is common
post-lumbar puncture but not as concerning. Mild discomfort is expected.
Temperature 37.2°C is normal.
11 A nurse is evaluating a patient's arterial blood gas results: pH 7.25, PaCO2
60 mm Hg, HCO3- 24 mEq/L. Which acid-base imbalance is present, and
what is the primary compensatory mechanism?
A) Respiratory acidosis; renal retention of bicarbonate
B) Respiratory alkalosis; renal excretion of bicarbonate
