NU 136
EXAM 3
Fundamentals of Nursing
Actual Questions w/Correct Answers
Galen College of Nursing
What you Will Get:
• 50+ verified questions
• Correct answers with Rationales.
• Ideal for exam preparation and concept
reinforcement.
,Question 1.
The nurse is preparing to reinforce teaching about new medications with a client
who speaks little English. Which of the following actions is the BEST for the
nurse to take?
A. Ask the client’s family member to translate the information.
B. Obtain an approved facility interpreter to translate the information.
C. Use a translation application on a personal smartphone.
D. Provide the client with written pamphlets in English.
Correct Answer: B
Rationale: Using an approved medical interpreter ensures accurate translation of
medical terminology, maintains confidentiality, and complies with The Joint Commission
and facility standards. Family members may omit or alter information, add emotional
burden, or breach confidentiality. Smartphone apps lack verification of medical
accuracy, and English pamphlets are inappropriate when the client has limited English
proficiency.
Question 2.
The nurse is collecting data for a newly admitted school-age child who is sitting
in the lap of a parent. Which of the following actions should the nurse take to
facilitate effective communication?
A. Stand at the bedside to maintain professional authority.
B. Ask the parent to leave so the child can answer independently.
C. Sit eye level with the child.
D. Direct all questions to the parent to avoid frightening the child.
Correct Answer: C
Rationale: Sitting at eye level with a child reduces the psychological and physical
barrier created by height differences, conveys respect, and establishes trust. Standing
over the child can be intimidating. While parents are valuable sources of information,
the nurse should still engage the child directly in an age-appropriate manner.
Question 3.
The nurse is caring for an older adult client who has developed pneumonia. The
client is receiving oxygen via nasal cannula and is frequently coughing with
, expectoration of thick, sticky secretions. The client reports feeling short of breath
and exhausted. Which of the following nursing diagnoses should the nurse
suggest implementing for this client?
A. Impaired gas exchange related to alveolar inflammation.
B. Alteration in airway clearance related to lung secretions as evidenced by cough and
shortness of breath.
C. Activity intolerance related to generalized weakness.
D. Ineffective breathing pattern related to pain on inspiration.
Correct Answer: B
Rationale: The defining characteristics—thick secretions, frequent cough, shortness of
breath, and exhaustion—directly support a diagnosis of Altered/Impaired Airway
Clearance. This diagnosis specifically addresses the client’s inability to clear secretions
effectively. While impaired gas exchange (A) and activity intolerance (C) may be
present, the priority data cluster points to airway clearance as the primary problem.
Question 4.
The nurse is contributing to the care planning process for an assigned client. The
client has been assigned the following nursing diagnoses. Which
diagnosis/problem is the priority?
A. Anxiety related to hospitalization.
B. Altered tissue perfusion related to hypovolemia.
C. Risk for impaired skin integrity related to immobility.
D. Disturbed body image related to surgical changes.
Correct Answer: B
Rationale: Nursing diagnoses are prioritized using Maslow’s Hierarchy of Needs and
the ABC framework (Airway, Breathing, Circulation). Physiological needs related to
oxygenation and perfusion take precedence over safety, psychosocial, or self-esteem
needs. Altered tissue perfusion is a life-threatening physiological priority requiring
immediate intervention.
Question 5.
The nurse is in the evaluation phase of the nursing process. Which of the
following actions does the nurse demonstrate during this phase?
EXAM 3
Fundamentals of Nursing
Actual Questions w/Correct Answers
Galen College of Nursing
What you Will Get:
• 50+ verified questions
• Correct answers with Rationales.
• Ideal for exam preparation and concept
reinforcement.
,Question 1.
The nurse is preparing to reinforce teaching about new medications with a client
who speaks little English. Which of the following actions is the BEST for the
nurse to take?
A. Ask the client’s family member to translate the information.
B. Obtain an approved facility interpreter to translate the information.
C. Use a translation application on a personal smartphone.
D. Provide the client with written pamphlets in English.
Correct Answer: B
Rationale: Using an approved medical interpreter ensures accurate translation of
medical terminology, maintains confidentiality, and complies with The Joint Commission
and facility standards. Family members may omit or alter information, add emotional
burden, or breach confidentiality. Smartphone apps lack verification of medical
accuracy, and English pamphlets are inappropriate when the client has limited English
proficiency.
Question 2.
The nurse is collecting data for a newly admitted school-age child who is sitting
in the lap of a parent. Which of the following actions should the nurse take to
facilitate effective communication?
A. Stand at the bedside to maintain professional authority.
B. Ask the parent to leave so the child can answer independently.
C. Sit eye level with the child.
D. Direct all questions to the parent to avoid frightening the child.
Correct Answer: C
Rationale: Sitting at eye level with a child reduces the psychological and physical
barrier created by height differences, conveys respect, and establishes trust. Standing
over the child can be intimidating. While parents are valuable sources of information,
the nurse should still engage the child directly in an age-appropriate manner.
Question 3.
The nurse is caring for an older adult client who has developed pneumonia. The
client is receiving oxygen via nasal cannula and is frequently coughing with
, expectoration of thick, sticky secretions. The client reports feeling short of breath
and exhausted. Which of the following nursing diagnoses should the nurse
suggest implementing for this client?
A. Impaired gas exchange related to alveolar inflammation.
B. Alteration in airway clearance related to lung secretions as evidenced by cough and
shortness of breath.
C. Activity intolerance related to generalized weakness.
D. Ineffective breathing pattern related to pain on inspiration.
Correct Answer: B
Rationale: The defining characteristics—thick secretions, frequent cough, shortness of
breath, and exhaustion—directly support a diagnosis of Altered/Impaired Airway
Clearance. This diagnosis specifically addresses the client’s inability to clear secretions
effectively. While impaired gas exchange (A) and activity intolerance (C) may be
present, the priority data cluster points to airway clearance as the primary problem.
Question 4.
The nurse is contributing to the care planning process for an assigned client. The
client has been assigned the following nursing diagnoses. Which
diagnosis/problem is the priority?
A. Anxiety related to hospitalization.
B. Altered tissue perfusion related to hypovolemia.
C. Risk for impaired skin integrity related to immobility.
D. Disturbed body image related to surgical changes.
Correct Answer: B
Rationale: Nursing diagnoses are prioritized using Maslow’s Hierarchy of Needs and
the ABC framework (Airway, Breathing, Circulation). Physiological needs related to
oxygenation and perfusion take precedence over safety, psychosocial, or self-esteem
needs. Altered tissue perfusion is a life-threatening physiological priority requiring
immediate intervention.
Question 5.
The nurse is in the evaluation phase of the nursing process. Which of the
following actions does the nurse demonstrate during this phase?
