,NSG 3250 Exam 1 | Adult Health I (2026/2027) PDF |
Nursing | Galen College
1. Which of the following best describes the primary purpose of the nursing
process?
A) To provide a systematic framework for delivering individualized care
B) To replace clinical judgment with standardized protocols
C) To ensure all clients receive identical treatment plans
D) To reduce the time nurses spend documenting care
Correct Answer: To provide a systematic framework for delivering individualized
care
Rationale: The nursing process is a cyclical, five-step framework (assessment,
diagnosis, planning, implementation, evaluation) that guides nurses in
delivering holistic, client-centered care. It promotes clinical reasoning and
individualized interventions rather than rigid standardization. It does not
replace clinical judgment or reduce documentation time; instead, it structures
decision-making to improve outcomes.
2. What is the primary function of the assessment phase in the nursing process?
A) To establish patient goals and expected outcomes
B) To systematically collect and analyze patient data
C) To implement nursing interventions based on evidence
D) To evaluate the effectiveness of nursing care
,Correct Answer: To systematically collect and analyze patient data
Rationale: The assessment phase is the first step of the nursing process,
involving the systematic collection of subjective and objective data through
history taking, physical examination, and diagnostic testing. This data forms the
foundation for identifying patient problems and planning care. Goal setting
occurs during planning, implementation involves carrying out interventions, and
evaluation determines whether outcomes were met.
3. According to the NCSBN Clinical Judgment Measurement Model, which layer
immediately follows "Analyze Cues"?
A) Take Actions
B) Recognize Cues
C) Prioritize Hypotheses
D) Evaluate Outcomes
Correct Answer: Prioritize Hypotheses
Rationale: The NCSBN CJMM consists of six layers: Recognize Cues, Analyze
Cues, Prioritize Hypotheses, Generate Solutions, Take Actions, and Evaluate
Outcomes. After analyzing cues, the nurse prioritizes hypotheses to determine
which patient problems are most urgent. Taking actions and evaluating
outcomes occur later in the model.
4. A patient's arterial blood gas (ABG) results are: pH 7.31, PaCO2 50 mmHg, and
HCO3 24 mEq/L. Which acid-base imbalance does this indicate?
, A) Metabolic Acidosis
B) Metabolic Alkalosis
C) Respiratory Acidosis
D) Respiratory Alkalosis
Correct Answer: Respiratory Acidosis
Rationale: The pH is below 7.35 (acidosis) and the PaCO2 is above 45 mmHg
(respiratory origin), while the bicarbonate is within normal limits, indicating
uncompensated respiratory acidosis. Metabolic acidosis would show a low
bicarbonate, and metabolic alkalosis would show a high pH and high
bicarbonate. Respiratory alkalosis would show a high pH and low PaCO2.
5. A nurse is caring for a patient who is 24 hours postoperative from abdominal
surgery. Which finding requires immediate intervention?
A) A temperature of 37.8 degrees Celsius
B) A heart rate of 96 beats per minute
C) A urinary output of 20 mL per hour
D) A blood pressure of 118/76 mmHg
Correct Answer: A urinary output of 20 mL per hour
Rationale: Urinary output below 30 mL per hour indicates inadequate renal
perfusion and may signal hypovolemia, shock, or urinary tract obstruction.
Nursing | Galen College
1. Which of the following best describes the primary purpose of the nursing
process?
A) To provide a systematic framework for delivering individualized care
B) To replace clinical judgment with standardized protocols
C) To ensure all clients receive identical treatment plans
D) To reduce the time nurses spend documenting care
Correct Answer: To provide a systematic framework for delivering individualized
care
Rationale: The nursing process is a cyclical, five-step framework (assessment,
diagnosis, planning, implementation, evaluation) that guides nurses in
delivering holistic, client-centered care. It promotes clinical reasoning and
individualized interventions rather than rigid standardization. It does not
replace clinical judgment or reduce documentation time; instead, it structures
decision-making to improve outcomes.
2. What is the primary function of the assessment phase in the nursing process?
A) To establish patient goals and expected outcomes
B) To systematically collect and analyze patient data
C) To implement nursing interventions based on evidence
D) To evaluate the effectiveness of nursing care
,Correct Answer: To systematically collect and analyze patient data
Rationale: The assessment phase is the first step of the nursing process,
involving the systematic collection of subjective and objective data through
history taking, physical examination, and diagnostic testing. This data forms the
foundation for identifying patient problems and planning care. Goal setting
occurs during planning, implementation involves carrying out interventions, and
evaluation determines whether outcomes were met.
3. According to the NCSBN Clinical Judgment Measurement Model, which layer
immediately follows "Analyze Cues"?
A) Take Actions
B) Recognize Cues
C) Prioritize Hypotheses
D) Evaluate Outcomes
Correct Answer: Prioritize Hypotheses
Rationale: The NCSBN CJMM consists of six layers: Recognize Cues, Analyze
Cues, Prioritize Hypotheses, Generate Solutions, Take Actions, and Evaluate
Outcomes. After analyzing cues, the nurse prioritizes hypotheses to determine
which patient problems are most urgent. Taking actions and evaluating
outcomes occur later in the model.
4. A patient's arterial blood gas (ABG) results are: pH 7.31, PaCO2 50 mmHg, and
HCO3 24 mEq/L. Which acid-base imbalance does this indicate?
, A) Metabolic Acidosis
B) Metabolic Alkalosis
C) Respiratory Acidosis
D) Respiratory Alkalosis
Correct Answer: Respiratory Acidosis
Rationale: The pH is below 7.35 (acidosis) and the PaCO2 is above 45 mmHg
(respiratory origin), while the bicarbonate is within normal limits, indicating
uncompensated respiratory acidosis. Metabolic acidosis would show a low
bicarbonate, and metabolic alkalosis would show a high pH and high
bicarbonate. Respiratory alkalosis would show a high pH and low PaCO2.
5. A nurse is caring for a patient who is 24 hours postoperative from abdominal
surgery. Which finding requires immediate intervention?
A) A temperature of 37.8 degrees Celsius
B) A heart rate of 96 beats per minute
C) A urinary output of 20 mL per hour
D) A blood pressure of 118/76 mmHg
Correct Answer: A urinary output of 20 mL per hour
Rationale: Urinary output below 30 mL per hour indicates inadequate renal
perfusion and may signal hypovolemia, shock, or urinary tract obstruction.
