Galen College NSG 3000 Exam 2 (pdf) | 2026/2027 | Foundations
Q&A | Professional Nursing Practice
1. The nurse is preparing to assess a patient's blood pressure. Which
Korotkoff sound indicates the systolic blood pressure?
A) The first clear tapping sound
B) The sound that becomes muffled
C) The sound that disappears
D) A swishing sound
Correct Answer: The first clear tapping sound
Rationale: The first clear tapping sound (Phase I) corresponds to the systolic
blood pressure. The point at which the sound disappears (Phase V) indicates
the diastolic pressure in adults. Muffled sounds (Phase IV) may be used for
diastolic pressure in some cases.
2. The nurse is assessing a patient's respiratory rate and notes it is 26
breaths per minute. Which term best describes this finding?
A) Bradypnea
B) Tachypnea
C) Hyperpnea
D) Apnea
Correct Answer: Tachypnea
Rationale: Tachypnea is an abnormally fast respiratory rate, typically greater
than 20 breaths per minute in adults. Bradypnea is a slow rate, hyperpnea is
deep breathing, and apnea is the absence of breathing.
,3. Which of the following is the most accurate method for measuring body
temperature?
A) Axillary
B) Tympanic
C) Oral
D) Rectal
Correct Answer: Rectal
Rationale: Rectal temperature is considered the most accurate method as it
reflects core body temperature. However, it is invasive and may be
contraindicated in certain patients. Oral temperatures are convenient but
can be affected by food or drink intake.
4. A patient has an order for an apical pulse. Where should the nurse place
the stethoscope to auscultate this pulse?
A) Second intercostal space, left sternal border
B) Fifth intercostal space, midclavicular line
C) Fourth intercostal space, right sternal border
D) Second intercostal space, right sternal border
Correct Answer: Fifth intercostal space, midclavicular line
Rationale: The apical pulse is auscultated at the apex of the heart, which is
located in the fifth intercostal space at the midclavicular line. This point is
also known as the point of maximal impulse (PMI).
5. The nurse is preparing to assess a patient's oxygen saturation using pulse
oximetry. Which of the following factors can affect the accuracy of the
reading?
,A) The patient's blood pressure
B) The presence of nail polish
C) The patient's temperature
D) All of the above
Correct Answer: All of the above
Rationale: Pulse oximetry accuracy can be affected by several factors,
including hypotension (poor perfusion), nail polish or artificial nails (which
can interfere with light transmission), and hypothermia (which can cause
vasoconstriction).
6. The nurse is assessing a patient's pain level using a 0-10 numeric rating
scale. The patient rates their pain as a 7. Which of the following is the most
appropriate nursing action?
A) Document the pain score and reassess later
B) Administer a PRN analgesic as ordered
C) Notify the healthcare provider immediately
D) Encourage the patient to use non-pharmacological techniques
Correct Answer: Administer a PRN analgesic as ordered
Rationale: A pain score of 7 indicates moderate to severe pain that requires
intervention. The nurse should administer a PRN analgesic as ordered. The
patient's response should then be reassessed.
7. A patient is at risk for skin breakdown. Which of the following interventions
should the nurse include in the plan of care?
A) Massage bony prominences
, B) Reposition the patient every 2 hours
C) Use a donut-shaped cushion
D) Apply a moisture barrier cream
Correct Answer: Reposition the patient every 2 hours
Rationale: Repositioning is the most effective intervention to relieve pressure
on bony prominences, which is the primary cause of pressure ulcers.
Massaging is no longer recommended, and donut-shaped cushions can
impair circulation.
8. The nurse is assessing a patient's skin and notes an area of non-
blanchable erythema over the sacrum. Which stage of pressure ulcer is this?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
Correct Answer: Stage 1
Rationale: Stage 1 pressure ulcers are characterized by intact skin with non-
blanchable erythema, indicating localized tissue damage. Stage 2 involves
partial-thickness skin loss, Stage 3 involves full-thickness skin loss, and
Stage 4 involves full-thickness tissue loss with exposed bone, tendon, or
muscle.
9. The nurse is caring for a patient with a Stage 3 pressure ulcer. Which type
of dressing is most appropriate for this wound?
A) Transparent film
B) Hydrocolloid
Q&A | Professional Nursing Practice
1. The nurse is preparing to assess a patient's blood pressure. Which
Korotkoff sound indicates the systolic blood pressure?
A) The first clear tapping sound
B) The sound that becomes muffled
C) The sound that disappears
D) A swishing sound
Correct Answer: The first clear tapping sound
Rationale: The first clear tapping sound (Phase I) corresponds to the systolic
blood pressure. The point at which the sound disappears (Phase V) indicates
the diastolic pressure in adults. Muffled sounds (Phase IV) may be used for
diastolic pressure in some cases.
2. The nurse is assessing a patient's respiratory rate and notes it is 26
breaths per minute. Which term best describes this finding?
A) Bradypnea
B) Tachypnea
C) Hyperpnea
D) Apnea
Correct Answer: Tachypnea
Rationale: Tachypnea is an abnormally fast respiratory rate, typically greater
than 20 breaths per minute in adults. Bradypnea is a slow rate, hyperpnea is
deep breathing, and apnea is the absence of breathing.
,3. Which of the following is the most accurate method for measuring body
temperature?
A) Axillary
B) Tympanic
C) Oral
D) Rectal
Correct Answer: Rectal
Rationale: Rectal temperature is considered the most accurate method as it
reflects core body temperature. However, it is invasive and may be
contraindicated in certain patients. Oral temperatures are convenient but
can be affected by food or drink intake.
4. A patient has an order for an apical pulse. Where should the nurse place
the stethoscope to auscultate this pulse?
A) Second intercostal space, left sternal border
B) Fifth intercostal space, midclavicular line
C) Fourth intercostal space, right sternal border
D) Second intercostal space, right sternal border
Correct Answer: Fifth intercostal space, midclavicular line
Rationale: The apical pulse is auscultated at the apex of the heart, which is
located in the fifth intercostal space at the midclavicular line. This point is
also known as the point of maximal impulse (PMI).
5. The nurse is preparing to assess a patient's oxygen saturation using pulse
oximetry. Which of the following factors can affect the accuracy of the
reading?
,A) The patient's blood pressure
B) The presence of nail polish
C) The patient's temperature
D) All of the above
Correct Answer: All of the above
Rationale: Pulse oximetry accuracy can be affected by several factors,
including hypotension (poor perfusion), nail polish or artificial nails (which
can interfere with light transmission), and hypothermia (which can cause
vasoconstriction).
6. The nurse is assessing a patient's pain level using a 0-10 numeric rating
scale. The patient rates their pain as a 7. Which of the following is the most
appropriate nursing action?
A) Document the pain score and reassess later
B) Administer a PRN analgesic as ordered
C) Notify the healthcare provider immediately
D) Encourage the patient to use non-pharmacological techniques
Correct Answer: Administer a PRN analgesic as ordered
Rationale: A pain score of 7 indicates moderate to severe pain that requires
intervention. The nurse should administer a PRN analgesic as ordered. The
patient's response should then be reassessed.
7. A patient is at risk for skin breakdown. Which of the following interventions
should the nurse include in the plan of care?
A) Massage bony prominences
, B) Reposition the patient every 2 hours
C) Use a donut-shaped cushion
D) Apply a moisture barrier cream
Correct Answer: Reposition the patient every 2 hours
Rationale: Repositioning is the most effective intervention to relieve pressure
on bony prominences, which is the primary cause of pressure ulcers.
Massaging is no longer recommended, and donut-shaped cushions can
impair circulation.
8. The nurse is assessing a patient's skin and notes an area of non-
blanchable erythema over the sacrum. Which stage of pressure ulcer is this?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
Correct Answer: Stage 1
Rationale: Stage 1 pressure ulcers are characterized by intact skin with non-
blanchable erythema, indicating localized tissue damage. Stage 2 involves
partial-thickness skin loss, Stage 3 involves full-thickness skin loss, and
Stage 4 involves full-thickness tissue loss with exposed bone, tendon, or
muscle.
9. The nurse is caring for a patient with a Stage 3 pressure ulcer. Which type
of dressing is most appropriate for this wound?
A) Transparent film
B) Hydrocolloid
