NSG 3100 Midterm Exam Questions with
Correct Answers (VerifiedAnswers) Plus
Detailed Rationales 2026 Q&A Instant
Download PDF
Question 1
A nurse is assessing a client who has just been admitted to a
medical-surgical unit. Which assessment should the nurse
perform first?
A. Review the client's dietary preferences
B. Ask about the client's usual sleep pattern
C. Assess airway, breathing, and circulation
D. Determine the client's preferred learning style
Correct Answer: C. Assess airway, breathing, and circulation
The ABC approach establishes immediate physiologic priorities.
Airway obstruction, impaired breathing, or inadequate
circulation can rapidly become life-threatening and therefore
take precedence over psychosocial, nutritional, or routine
assessment information. The nurse should first determine
whether the client can maintain a patent airway, is adequately
ventilating and oxygenating, and has sufficient circulation. Once
,immediate threats have been addressed, the nurse can proceed
with a comprehensive assessment.
Question 2
Which finding is most concerning when a nurse assesses a client
experiencing acute respiratory distress?
A. Respiratory rate of 20/min
B. Mild anxiety
C. Cyanosis and increasing confusion
D. Occasional nonproductive cough
Correct Answer: C. Cyanosis and increasing confusion
Cyanosis and altered mental status can indicate significant
hypoxemia. As oxygenation deteriorates, the brain may be
affected, producing restlessness, confusion, and eventually
decreased level of consciousness. Cyanosis is a late and
concerning sign of inadequate oxygenation. The nurse should
respond promptly by assessing the airway and breathing,
administering oxygen as prescribed or according to protocol,
and escalating care when necessary.
Question 3
,A nurse is preparing to administer medication to a client. Which
action best promotes medication safety?
A. Administer the medication based only on the room number
B. Ask another client to identify the medication
C. Use two appropriate client identifiers before administration
D. Prepare medications for several clients at the same time
Correct Answer: C. Use two appropriate client identifiers
before administration
Using two approved identifiers helps prevent wrong-patient
medication errors. Appropriate identifiers commonly include the
client's name and another identifier such as date of birth or
medical record number. The room number should not be used as
an identifier because clients can be moved or assigned different
rooms. Preparing medications for multiple clients
simultaneously can also increase the risk of mix-ups and should
be avoided.
Question 4
Which nursing intervention is most appropriate for preventing
pressure injuries in an immobile client?
A. Massage reddened bony prominences vigorously
B. Keep the client in one position to prevent discomfort
C. Reposition the client regularly and reduce pressure on
, vulnerable areas
D. Apply heat directly to areas of redness
Correct Answer: C. Reposition the client regularly and reduce
pressure on vulnerable areas
Prolonged pressure can impair blood flow to tissues over bony
prominences and contribute to pressure injury formation.
Regular repositioning, appropriate support surfaces, moisture
management, adequate nutrition, and frequent skin assessment
help reduce risk. Vigorous massage over reddened areas can
damage already compromised tissue, while direct heat can
increase tissue injury and does not correct the underlying
pressure.
Question 5
A client reports severe pain after surgery. Which nursing action
is most appropriate?
A. Tell the client that postoperative pain is expected
B. Wait until the pain becomes unbearable before intervening
C. Assess the pain and administer prescribed analgesia
appropriately
D. Avoid medication because opioids always cause respiratory
failure
Correct Answers (VerifiedAnswers) Plus
Detailed Rationales 2026 Q&A Instant
Download PDF
Question 1
A nurse is assessing a client who has just been admitted to a
medical-surgical unit. Which assessment should the nurse
perform first?
A. Review the client's dietary preferences
B. Ask about the client's usual sleep pattern
C. Assess airway, breathing, and circulation
D. Determine the client's preferred learning style
Correct Answer: C. Assess airway, breathing, and circulation
The ABC approach establishes immediate physiologic priorities.
Airway obstruction, impaired breathing, or inadequate
circulation can rapidly become life-threatening and therefore
take precedence over psychosocial, nutritional, or routine
assessment information. The nurse should first determine
whether the client can maintain a patent airway, is adequately
ventilating and oxygenating, and has sufficient circulation. Once
,immediate threats have been addressed, the nurse can proceed
with a comprehensive assessment.
Question 2
Which finding is most concerning when a nurse assesses a client
experiencing acute respiratory distress?
A. Respiratory rate of 20/min
B. Mild anxiety
C. Cyanosis and increasing confusion
D. Occasional nonproductive cough
Correct Answer: C. Cyanosis and increasing confusion
Cyanosis and altered mental status can indicate significant
hypoxemia. As oxygenation deteriorates, the brain may be
affected, producing restlessness, confusion, and eventually
decreased level of consciousness. Cyanosis is a late and
concerning sign of inadequate oxygenation. The nurse should
respond promptly by assessing the airway and breathing,
administering oxygen as prescribed or according to protocol,
and escalating care when necessary.
Question 3
,A nurse is preparing to administer medication to a client. Which
action best promotes medication safety?
A. Administer the medication based only on the room number
B. Ask another client to identify the medication
C. Use two appropriate client identifiers before administration
D. Prepare medications for several clients at the same time
Correct Answer: C. Use two appropriate client identifiers
before administration
Using two approved identifiers helps prevent wrong-patient
medication errors. Appropriate identifiers commonly include the
client's name and another identifier such as date of birth or
medical record number. The room number should not be used as
an identifier because clients can be moved or assigned different
rooms. Preparing medications for multiple clients
simultaneously can also increase the risk of mix-ups and should
be avoided.
Question 4
Which nursing intervention is most appropriate for preventing
pressure injuries in an immobile client?
A. Massage reddened bony prominences vigorously
B. Keep the client in one position to prevent discomfort
C. Reposition the client regularly and reduce pressure on
, vulnerable areas
D. Apply heat directly to areas of redness
Correct Answer: C. Reposition the client regularly and reduce
pressure on vulnerable areas
Prolonged pressure can impair blood flow to tissues over bony
prominences and contribute to pressure injury formation.
Regular repositioning, appropriate support surfaces, moisture
management, adequate nutrition, and frequent skin assessment
help reduce risk. Vigorous massage over reddened areas can
damage already compromised tissue, while direct heat can
increase tissue injury and does not correct the underlying
pressure.
Question 5
A client reports severe pain after surgery. Which nursing action
is most appropriate?
A. Tell the client that postoperative pain is expected
B. Wait until the pain becomes unbearable before intervening
C. Assess the pain and administer prescribed analgesia
appropriately
D. Avoid medication because opioids always cause respiratory
failure
