NSG 3100 FUNDAMENTALS OF NURSING EXAM 4 ACTUAL
2026/2027 | 50 New Questions | Galen College | Graded A+ |
Pass Guaranteed - A+ Graded
Section 1: Comprehensive Health Assessment & Documentation (Q1-12)
Q1. During a comprehensive abdominal assessment, the nurse uses which examination
sequence to prevent altering bowel sounds?
A. Inspection, palpation, percussion, auscultation
B. Inspection, auscultation, percussion, palpation [CORRECT]
C. Auscultation, inspection, palpation, percussion
D. Percussion, inspection, auscultation, palpation
Rationale: Palpation and percussion can alter bowel sounds, so auscultation must
precede these techniques during abdominal assessment. The correct sequence is
inspection, auscultation, percussion, palpation.
Correct Answer: B
Q2. Rhonchi are best described as which type of breath sound?
A. High-pitched musical sounds heard during inspiration and expiration
B. Low-pitched, continuous, snoring-like sounds typically heard during expiration
[CORRECT]
C. Fine, popping, discontinuous sounds heard during late inspiration
D. Harsh, grating sounds heard during both phases of respiration
Rationale: Rhonchi are low-pitched, continuous, snoring-like sounds caused by
secretions in larger airways. Wheezes are high-pitched musical sounds, crackles are
fine popping sounds, and pleural friction rubs are grating sounds.
Correct Answer: B
Q3. While assessing a patient with heart failure, the nurse auscultates a blowing,
holosystolic sound at the apex radiating to the axilla. This finding is documented as:
A. S3 gallop
B. S4 gallop
C. Mitral regurgitation murmur [CORRECT]
,D. Pericardial friction rub
Rationale: A holosystolic blowing murmur at the apex radiating to the axilla indicates
mitral regurgitation. S3 is an early diastolic sound, S4 is a late diastolic sound, and
pericardial friction rub is a scratching sound heard throughout the cardiac cycle.
Correct Answer: C
Q4. A nurse palpates the carotid arteries and detects an audible, turbulent, whooshing
sound. The correct documentation for this finding is:
A. Carotid bruit [CORRECT]
B. Carotid thrill
C. Jugular venous distention
D. Carotid stenosis
Rationale: A bruit is an audible vascular sound indicating turbulent blood flow, typically
caused by atherosclerotic narrowing. A thrill is palpable (not audible), JVD is venous
distention, and stenosis is the underlying condition rather than the assessment finding.
Correct Answer: A
Q5. Using the standardized edema grading scale, 4+ pitting edema is characterized by:
A. A 2mm indentation that rebounds immediately
B. A 4mm indentation that rebounds in 10-15 seconds
C. A 6mm indentation that may last >1 minute
D. An indentation >8mm that may last >2 minutes [CORRECT]
Rationale: 4+ edema presents as an indentation >8mm that may last >2 minutes,
indicating severe fluid accumulation. 1+ is 2mm, 2+ is 4mm, and 3+ is 6mm indentation.
Correct Answer: D
Q6. During a postoperative assessment, the nurse notes absent bowel sounds in all four
quadrants after listening for 5 minutes. The appropriate documentation and action are:
A. Document "hypoactive bowel sounds" and continue routine monitoring
B. Document "absent bowel sounds" and notify the provider immediately [CORRECT]
C. Document "normal bowel sounds" and encourage ambulation
D. Document "hyperactive bowel sounds" and place the patient NPO
, Rationale: Absent bowel sounds (no sounds heard in 5 minutes) may indicate paralytic
ileus or peritonitis, requiring immediate provider notification. Hypoactive sounds are
diminished but present, and hyperactive sounds indicate increased motility.
Correct Answer: B
Q7. A nurse is preparing to communicate a patient's deteriorating respiratory status to
the provider using SBAR. Which component includes the nurse's recommendation for
immediate chest X-ray and arterial blood gas analysis?
A. Situation
B. Background
C. Assessment
D. Recommendation [CORRECT]
Rationale: The Recommendation component of SBAR includes specific nursing
requests or suggested interventions, such as diagnostic tests or treatments needed.
Situation describes the current problem, Background provides context, and Assessment
shares clinical analysis.
Correct Answer: D
Q8. When using ISBARR for handoff communication, the nurse states, "I recommend we
obtain a STAT 12-lead ECG and cardiology consult." This statement corresponds to
which ISBARR element?
A. Identity
B. Assessment
C. Recommendation [CORRECT]
D. Read back
Rationale: The Recommendation component includes specific suggested actions or
orders requested from the provider. Identity introduces the patient, Assessment shares
clinical judgment, and Read back confirms understanding of received orders.
Correct Answer: C
Q9. A nurse documents: "Patient reports pain 8/10, guarding lower abdomen, skin
diaphoretic, BP 92/58, HR 118." The charge nurse requests revision using QPEE format.
Which revision best demonstrates QPEE structure?
A. "Patient appears uncomfortable with abdominal pain"
2026/2027 | 50 New Questions | Galen College | Graded A+ |
Pass Guaranteed - A+ Graded
Section 1: Comprehensive Health Assessment & Documentation (Q1-12)
Q1. During a comprehensive abdominal assessment, the nurse uses which examination
sequence to prevent altering bowel sounds?
A. Inspection, palpation, percussion, auscultation
B. Inspection, auscultation, percussion, palpation [CORRECT]
C. Auscultation, inspection, palpation, percussion
D. Percussion, inspection, auscultation, palpation
Rationale: Palpation and percussion can alter bowel sounds, so auscultation must
precede these techniques during abdominal assessment. The correct sequence is
inspection, auscultation, percussion, palpation.
Correct Answer: B
Q2. Rhonchi are best described as which type of breath sound?
A. High-pitched musical sounds heard during inspiration and expiration
B. Low-pitched, continuous, snoring-like sounds typically heard during expiration
[CORRECT]
C. Fine, popping, discontinuous sounds heard during late inspiration
D. Harsh, grating sounds heard during both phases of respiration
Rationale: Rhonchi are low-pitched, continuous, snoring-like sounds caused by
secretions in larger airways. Wheezes are high-pitched musical sounds, crackles are
fine popping sounds, and pleural friction rubs are grating sounds.
Correct Answer: B
Q3. While assessing a patient with heart failure, the nurse auscultates a blowing,
holosystolic sound at the apex radiating to the axilla. This finding is documented as:
A. S3 gallop
B. S4 gallop
C. Mitral regurgitation murmur [CORRECT]
,D. Pericardial friction rub
Rationale: A holosystolic blowing murmur at the apex radiating to the axilla indicates
mitral regurgitation. S3 is an early diastolic sound, S4 is a late diastolic sound, and
pericardial friction rub is a scratching sound heard throughout the cardiac cycle.
Correct Answer: C
Q4. A nurse palpates the carotid arteries and detects an audible, turbulent, whooshing
sound. The correct documentation for this finding is:
A. Carotid bruit [CORRECT]
B. Carotid thrill
C. Jugular venous distention
D. Carotid stenosis
Rationale: A bruit is an audible vascular sound indicating turbulent blood flow, typically
caused by atherosclerotic narrowing. A thrill is palpable (not audible), JVD is venous
distention, and stenosis is the underlying condition rather than the assessment finding.
Correct Answer: A
Q5. Using the standardized edema grading scale, 4+ pitting edema is characterized by:
A. A 2mm indentation that rebounds immediately
B. A 4mm indentation that rebounds in 10-15 seconds
C. A 6mm indentation that may last >1 minute
D. An indentation >8mm that may last >2 minutes [CORRECT]
Rationale: 4+ edema presents as an indentation >8mm that may last >2 minutes,
indicating severe fluid accumulation. 1+ is 2mm, 2+ is 4mm, and 3+ is 6mm indentation.
Correct Answer: D
Q6. During a postoperative assessment, the nurse notes absent bowel sounds in all four
quadrants after listening for 5 minutes. The appropriate documentation and action are:
A. Document "hypoactive bowel sounds" and continue routine monitoring
B. Document "absent bowel sounds" and notify the provider immediately [CORRECT]
C. Document "normal bowel sounds" and encourage ambulation
D. Document "hyperactive bowel sounds" and place the patient NPO
, Rationale: Absent bowel sounds (no sounds heard in 5 minutes) may indicate paralytic
ileus or peritonitis, requiring immediate provider notification. Hypoactive sounds are
diminished but present, and hyperactive sounds indicate increased motility.
Correct Answer: B
Q7. A nurse is preparing to communicate a patient's deteriorating respiratory status to
the provider using SBAR. Which component includes the nurse's recommendation for
immediate chest X-ray and arterial blood gas analysis?
A. Situation
B. Background
C. Assessment
D. Recommendation [CORRECT]
Rationale: The Recommendation component of SBAR includes specific nursing
requests or suggested interventions, such as diagnostic tests or treatments needed.
Situation describes the current problem, Background provides context, and Assessment
shares clinical analysis.
Correct Answer: D
Q8. When using ISBARR for handoff communication, the nurse states, "I recommend we
obtain a STAT 12-lead ECG and cardiology consult." This statement corresponds to
which ISBARR element?
A. Identity
B. Assessment
C. Recommendation [CORRECT]
D. Read back
Rationale: The Recommendation component includes specific suggested actions or
orders requested from the provider. Identity introduces the patient, Assessment shares
clinical judgment, and Read back confirms understanding of received orders.
Correct Answer: C
Q9. A nurse documents: "Patient reports pain 8/10, guarding lower abdomen, skin
diaphoretic, BP 92/58, HR 118." The charge nurse requests revision using QPEE format.
Which revision best demonstrates QPEE structure?
A. "Patient appears uncomfortable with abdominal pain"
