,Galen NSG 3100 Exam 2 | Fundamental Concepts &
Skills for Nursing I (2026) Actual Q&A PDF
1. A client's oral temperature is 36.1°C (97.2°F) at 8:00 a.m. All other vital signs
are normal. What should the nurse do first?
A) Chart the temperature as normal.
B) Retake the temperature using a tympanic thermometer.
C) Check the client's previous temperature range.
D) Notify the health care provider.
Correct Answer: Check the client's previous temperature range.
Rationale: While 36.1°C is slightly low, it may be the client's baseline. Reviewing
prior readings prevents unnecessary intervention and identifies true deviations.
If the value is consistent, it can be documented. Retaking or notifying is
premature.
2. The nurse assesses an irregular radial pulse. Which action is most
appropriate?
A) Count the radial pulse for 30 seconds.
B) Count the apical pulse for one full minute.
C) Assess the carotid pulse.
D) Measure blood pressure immediately.
Correct Answer: Count the apical pulse for one full minute.
,Rationale: An irregular radial pulse may indicate an arrhythmia. Apical
auscultation for a full minute provides an accurate heart rate and rhythm.
Carotid assessment is used in emergencies; blood pressure does not confirm
rhythm.
3. A client's respiratory rate is 10 breaths per minute. The client is receiving
morphine via patient-controlled analgesia. What is the priority nursing action?
A) Document the finding and continue monitoring.
B) Administer naloxone.
C) Assess level of consciousness and oxygen saturation.
D) Notify the respiratory therapist.
Correct Answer: Assess level of consciousness and oxygen saturation.
Rationale: Bradypnea associated with opioid use requires immediate
assessment of sedation and SpO2. Naloxone may be needed if respiratory
depression is severe, but assessment must come first. Documentation alone is
insufficient.
4. Which client is most appropriate for the nurse to assess the apical pulse?
A) A client returning from a walk.
B) A client with atrial fibrillation.
C) A client with a temperature of 37.2°C.
D) A client with a respiratory rate of 18.
Correct Answer: A client with atrial fibrillation.
, Rationale: The apical site is used for clients with arrhythmias to accurately count
the rate and detect irregular rhythms. A radial pulse may miss ectopic beats.
Other options have normal or expected variations.
5. The nurse is measuring orthostatic vital signs. Which finding indicates
orthostatic hypotension?
A) Systolic BP rises 25 mm Hg upon standing.
B) Diastolic BP drops 5 mm Hg upon standing.
C) Systolic BP drops 25 mm Hg upon standing.
D) Heart rate remains unchanged.
Correct Answer: Systolic BP drops 25 mm Hg upon standing.
Rationale: Orthostatic hypotension is defined as a drop in systolic BP ≥20 mm
Hg or diastolic BP ≥10 mm Hg within 3 minutes of standing. A rise or minimal
change is not diagnostic.
6. A client's blood pressure is 180/110 mm Hg. The nurse rechecks and confirms
the reading. What is the priority action?
A) Notify the health care provider.
B) Administer antihypertensive medication as prescribed.
C) Place the client flat in bed.
D) Recheck in 15 minutes.
Correct Answer: Notify the health care provider.
Skills for Nursing I (2026) Actual Q&A PDF
1. A client's oral temperature is 36.1°C (97.2°F) at 8:00 a.m. All other vital signs
are normal. What should the nurse do first?
A) Chart the temperature as normal.
B) Retake the temperature using a tympanic thermometer.
C) Check the client's previous temperature range.
D) Notify the health care provider.
Correct Answer: Check the client's previous temperature range.
Rationale: While 36.1°C is slightly low, it may be the client's baseline. Reviewing
prior readings prevents unnecessary intervention and identifies true deviations.
If the value is consistent, it can be documented. Retaking or notifying is
premature.
2. The nurse assesses an irregular radial pulse. Which action is most
appropriate?
A) Count the radial pulse for 30 seconds.
B) Count the apical pulse for one full minute.
C) Assess the carotid pulse.
D) Measure blood pressure immediately.
Correct Answer: Count the apical pulse for one full minute.
,Rationale: An irregular radial pulse may indicate an arrhythmia. Apical
auscultation for a full minute provides an accurate heart rate and rhythm.
Carotid assessment is used in emergencies; blood pressure does not confirm
rhythm.
3. A client's respiratory rate is 10 breaths per minute. The client is receiving
morphine via patient-controlled analgesia. What is the priority nursing action?
A) Document the finding and continue monitoring.
B) Administer naloxone.
C) Assess level of consciousness and oxygen saturation.
D) Notify the respiratory therapist.
Correct Answer: Assess level of consciousness and oxygen saturation.
Rationale: Bradypnea associated with opioid use requires immediate
assessment of sedation and SpO2. Naloxone may be needed if respiratory
depression is severe, but assessment must come first. Documentation alone is
insufficient.
4. Which client is most appropriate for the nurse to assess the apical pulse?
A) A client returning from a walk.
B) A client with atrial fibrillation.
C) A client with a temperature of 37.2°C.
D) A client with a respiratory rate of 18.
Correct Answer: A client with atrial fibrillation.
, Rationale: The apical site is used for clients with arrhythmias to accurately count
the rate and detect irregular rhythms. A radial pulse may miss ectopic beats.
Other options have normal or expected variations.
5. The nurse is measuring orthostatic vital signs. Which finding indicates
orthostatic hypotension?
A) Systolic BP rises 25 mm Hg upon standing.
B) Diastolic BP drops 5 mm Hg upon standing.
C) Systolic BP drops 25 mm Hg upon standing.
D) Heart rate remains unchanged.
Correct Answer: Systolic BP drops 25 mm Hg upon standing.
Rationale: Orthostatic hypotension is defined as a drop in systolic BP ≥20 mm
Hg or diastolic BP ≥10 mm Hg within 3 minutes of standing. A rise or minimal
change is not diagnostic.
6. A client's blood pressure is 180/110 mm Hg. The nurse rechecks and confirms
the reading. What is the priority action?
A) Notify the health care provider.
B) Administer antihypertensive medication as prescribed.
C) Place the client flat in bed.
D) Recheck in 15 minutes.
Correct Answer: Notify the health care provider.
