NSG 3160 / NSG3160 Exam 1 | 2026/2027
Galen | Health Assessment | Questions &
Answers with Rationales | Grade A | Verified
Solutions
1. What is the most important step in the critical-thinking process?
A) Clustering subjective and objective data
B) Analyzing health data
C) Using evidence-based assessment techniques
D) Prioritizing health concerns
Answer: C) Using evidence-based assessment techniques
Rationale: Evidence-based techniques are supported by research and provide the
strongest foundation for clinical decision-making. The critical-thinking process begins
with gathering accurate, evidence-based data to ensure subsequent analysis and
prioritization are valid .
2. The nurse is receiving change-of-shift report. Using the nursing process, which
activity should the nurse anticipate first?
A) Collect and organize client data
B) Set client-centered, measurable, and realistic goals
C) Determine effectiveness of interventions
D) Critically analyze client data to determine priorities
Answer: A) Collect and organize client data
Rationale: The nursing process is sequential: Assessment is the first step, which involves
collecting and organizing client data. Goals cannot be set, interventions implemented, or
outcomes evaluated until assessment is complete .
,3. Which diagnosis is the highest priority according to Maslow's hierarchy of
needs?
A) Chronic pain
B) Activity intolerance
C) Risk for infection
D) Ineffective breathing pattern
Answer: D) Ineffective breathing pattern
Rationale: According to Maslow's hierarchy, physiological needs (airway, breathing,
circulation) are the highest priority. Ineffective breathing pattern represents an
immediate threat to oxygenation and life safety. Physiological needs must be addressed
before safety, love/belonging, esteem, or self-actualization needs .
4. The nurse reassesses a client's temperature 45 minutes after administering
acetaminophen. This is an example of what type of assessment?
A) Routine
B) Intermittent
C) Terminal
D) Ongoing
Answer: D) Ongoing
Rationale: Reassessing a patient's temperature after administering medication is an
example of an ongoing assessment. Ongoing assessments evaluate the effectiveness of
interventions and monitor changes in the patient's condition. Routine assessments are
scheduled; intermittent assessments occur as needed; terminal assessments are
performed at the end of life .
5. Which of the following is the correct sequence of steps in the nursing process?
A) Diagnosis, Assessment, Planning, Implementation, Evaluation
B) Assessment, Diagnosis, Planning, Implementation, Evaluation
C) Planning, Assessment, Diagnosis, Implementation, Evaluation
D) Assessment, Planning, Diagnosis, Implementation, Evaluation
Answer: B) Assessment, Diagnosis, Planning, Implementation, Evaluation
,Rationale: The nursing process follows a specific sequence: Assessment (collect data),
Diagnosis (identify problems), Planning (set goals and interventions), Implementation
(carry out interventions), and Evaluation (assess outcomes). This systematic approach
ensures thorough and organized patient care .
6. What should a nurse do before documenting an abnormal finding?
A) Document the finding immediately
B) Reassess, validate, confirm, then document
C) Wait for the provider to confirm
D) Ask another nurse to document
Answer: B) Reassess, validate, confirm, then document
Rationale: Before documenting abnormal findings, the nurse should reassess to confirm
the finding, validate with other data or the patient, and ensure accuracy. This prevents
documentation errors and ensures that reported findings are accurate and reliable .
7. The nurse is evaluating the reliability of a patient's responses. Which statement
is correct?
A) A patient with a history of drug abuse is not reliable
B) Reliability is established by verifying patient responses with medical records
C) Reliability is determined by the patient's ability to answer questions independently
D) Older adults are generally not reliable historians
Answer: C) Reliability is determined by the patient's ability to answer questions
independently
Rationale: Evaluating the reliability of a patient's responses involves assessing the
patient's ability to answer questions independently and consistently. The nurse should
consider whether the patient can answer questions without assistance and whether
responses are consistent throughout the interview .
8. The "A, B, C, and T" of the mental health assessment stands for:
A) Attitude, behavior, cleanliness, talk/speech
, B) Appearance, behavior, cognition, and thought
C) Airway, breathing, circulation
D) Ability, beliefs, culture, traditions
Answer: B) Appearance, behavior, cognition, and thought
Rationale: The A, B, C, and T of mental health assessment refer to Appearance, Behavior,
Cognition, and Thought processes. This framework provides a systematic approach to
evaluating a patient's mental status during a health assessment .
9. Which action demonstrates proper physical assessment technique?
A) Auscultating through the gown
B) Cleaning the stethoscope before assessment
C) Palpating the abdomen before auscultating
D) Pressing the bell of the stethoscope firmly
Answer: B) Cleaning the stethoscope before assessment
Rationale: Cleaning the stethoscope before assessment is a proper technique that
prevents the spread of infection between patients. Auscultating through the gown
interferes with sound transmission; palpation should follow auscultation of the abdomen
(which is performed first to avoid altering bowel sounds); the bell is held lightly, not
firmly .
10. The nursing process includes which of the following components?
A) Assessment, Diagnosis, Outcome Identification, Planning, Implementation, and
Evaluation
B) Assessment, Planning, Implementation, and Evaluation only
C) Diagnosis, Treatment, and Follow-up
D) History, Physical Exam, and Treatment Plan
Answer: A) Assessment, Diagnosis, Outcome Identification, Planning,
Implementation, and Evaluation
Galen | Health Assessment | Questions &
Answers with Rationales | Grade A | Verified
Solutions
1. What is the most important step in the critical-thinking process?
A) Clustering subjective and objective data
B) Analyzing health data
C) Using evidence-based assessment techniques
D) Prioritizing health concerns
Answer: C) Using evidence-based assessment techniques
Rationale: Evidence-based techniques are supported by research and provide the
strongest foundation for clinical decision-making. The critical-thinking process begins
with gathering accurate, evidence-based data to ensure subsequent analysis and
prioritization are valid .
2. The nurse is receiving change-of-shift report. Using the nursing process, which
activity should the nurse anticipate first?
A) Collect and organize client data
B) Set client-centered, measurable, and realistic goals
C) Determine effectiveness of interventions
D) Critically analyze client data to determine priorities
Answer: A) Collect and organize client data
Rationale: The nursing process is sequential: Assessment is the first step, which involves
collecting and organizing client data. Goals cannot be set, interventions implemented, or
outcomes evaluated until assessment is complete .
,3. Which diagnosis is the highest priority according to Maslow's hierarchy of
needs?
A) Chronic pain
B) Activity intolerance
C) Risk for infection
D) Ineffective breathing pattern
Answer: D) Ineffective breathing pattern
Rationale: According to Maslow's hierarchy, physiological needs (airway, breathing,
circulation) are the highest priority. Ineffective breathing pattern represents an
immediate threat to oxygenation and life safety. Physiological needs must be addressed
before safety, love/belonging, esteem, or self-actualization needs .
4. The nurse reassesses a client's temperature 45 minutes after administering
acetaminophen. This is an example of what type of assessment?
A) Routine
B) Intermittent
C) Terminal
D) Ongoing
Answer: D) Ongoing
Rationale: Reassessing a patient's temperature after administering medication is an
example of an ongoing assessment. Ongoing assessments evaluate the effectiveness of
interventions and monitor changes in the patient's condition. Routine assessments are
scheduled; intermittent assessments occur as needed; terminal assessments are
performed at the end of life .
5. Which of the following is the correct sequence of steps in the nursing process?
A) Diagnosis, Assessment, Planning, Implementation, Evaluation
B) Assessment, Diagnosis, Planning, Implementation, Evaluation
C) Planning, Assessment, Diagnosis, Implementation, Evaluation
D) Assessment, Planning, Diagnosis, Implementation, Evaluation
Answer: B) Assessment, Diagnosis, Planning, Implementation, Evaluation
,Rationale: The nursing process follows a specific sequence: Assessment (collect data),
Diagnosis (identify problems), Planning (set goals and interventions), Implementation
(carry out interventions), and Evaluation (assess outcomes). This systematic approach
ensures thorough and organized patient care .
6. What should a nurse do before documenting an abnormal finding?
A) Document the finding immediately
B) Reassess, validate, confirm, then document
C) Wait for the provider to confirm
D) Ask another nurse to document
Answer: B) Reassess, validate, confirm, then document
Rationale: Before documenting abnormal findings, the nurse should reassess to confirm
the finding, validate with other data or the patient, and ensure accuracy. This prevents
documentation errors and ensures that reported findings are accurate and reliable .
7. The nurse is evaluating the reliability of a patient's responses. Which statement
is correct?
A) A patient with a history of drug abuse is not reliable
B) Reliability is established by verifying patient responses with medical records
C) Reliability is determined by the patient's ability to answer questions independently
D) Older adults are generally not reliable historians
Answer: C) Reliability is determined by the patient's ability to answer questions
independently
Rationale: Evaluating the reliability of a patient's responses involves assessing the
patient's ability to answer questions independently and consistently. The nurse should
consider whether the patient can answer questions without assistance and whether
responses are consistent throughout the interview .
8. The "A, B, C, and T" of the mental health assessment stands for:
A) Attitude, behavior, cleanliness, talk/speech
, B) Appearance, behavior, cognition, and thought
C) Airway, breathing, circulation
D) Ability, beliefs, culture, traditions
Answer: B) Appearance, behavior, cognition, and thought
Rationale: The A, B, C, and T of mental health assessment refer to Appearance, Behavior,
Cognition, and Thought processes. This framework provides a systematic approach to
evaluating a patient's mental status during a health assessment .
9. Which action demonstrates proper physical assessment technique?
A) Auscultating through the gown
B) Cleaning the stethoscope before assessment
C) Palpating the abdomen before auscultating
D) Pressing the bell of the stethoscope firmly
Answer: B) Cleaning the stethoscope before assessment
Rationale: Cleaning the stethoscope before assessment is a proper technique that
prevents the spread of infection between patients. Auscultating through the gown
interferes with sound transmission; palpation should follow auscultation of the abdomen
(which is performed first to avoid altering bowel sounds); the bell is held lightly, not
firmly .
10. The nursing process includes which of the following components?
A) Assessment, Diagnosis, Outcome Identification, Planning, Implementation, and
Evaluation
B) Assessment, Planning, Implementation, and Evaluation only
C) Diagnosis, Treatment, and Follow-up
D) History, Physical Exam, and Treatment Plan
Answer: A) Assessment, Diagnosis, Outcome Identification, Planning,
Implementation, and Evaluation
