Galen NSG 4100 Exam 1 — Adult Health
GALEN COLLEGE OF NURSING
NSG 4100 – Nursing Practice: Adult Health — Exam 1 (2026/2027)
Instructions:
Total Questions: 60 (multiple-choice and select-all-that-apply) | Time Allowed: 2 hours | Passing Score:
75% (45/60)
For each question, select the single best answer unless otherwise indicated. SATA questions have multiple
correct responses.
Aligned with NGN (Next-Generation NCLEX) standards and QSEN competencies.
SECTION I: NURSING PROCESS & CLINICAL JUDGMENT
1. A nurse is caring for a client who was admitted with dehydration. Using the nursing
process, which action should the nurse perform FIRST?
A. Formulate a nursing diagnosis of Fluid Volume Deficit
B. Assess the client's vital signs, skin turgor, and urine output
C. Develop a plan of care for fluid replacement
D. Evaluate the client's response to IV fluid therapy
Correct Answer: B. Assess the client's vital signs, skin turgor, and urine output
Rationale: Assessment is the first step of the nursing process (ADPIE). The nurse must collect
comprehensive data before formulating a diagnosis, planning, implementing, or evaluating
interventions. Lewis's Medical-Surgical Nursing emphasizes that systematic assessment guides all
subsequent clinical decisions and is foundational to safe, patient-centered care.
2. According to Tanner's Clinical Judgment Model, which cognitive phase occurs when the
nurse notices that a postoperative patient's respiratory rate has increased from 16 to 28
breaths/min?
A. Interpreting
B. Responding
C. Noticing
D. Reflecting
Correct Answer: C. Noticing
Rationale: Tanner's model begins with Noticing — the nurse observes deviations from expected patterns.
Recognizing an elevated respiratory rate in a postoperative patient is an example of this initial phase.
1
, Galen NSG 4100 Exam 1 — Adult Health
Interpreting follows, where the nurse assigns meaning to the data. Responding involves choosing and
implementing interventions, and Reflecting evaluates the outcome of those interventions (Tanner, 2006).
3. A nurse is using the NCSBN Clinical Judgment Measurement Model (CJMM). After
recognizing cues that a patient may be developing sepsis, what is the NEXT step in the
model?
A. Generate solutions
B. Analyze cues
C. Take action
D. Evaluate outcomes
Correct Answer: B. Analyze cues
Rationale: The CJMM progresses from Recognize Cues → Analyze Cues → Prioritize Hypotheses →
Generate Solutions → Take Action → Evaluate Outcomes. After recognizing that a patient may have an
elevated temperature, heart rate, and altered mental status (potential sepsis cues), the nurse must
analyze these cues to determine their clinical significance before prioritizing hypotheses or taking action
(NCSBN, 2019).
4. The nurse receives morning report on four patients. Which patient should the nurse
assess FIRST based on the ABC prioritization framework?
A. A patient with type 2 diabetes requesting dietary education
B. A patient with a healed surgical wound awaiting discharge
C. A patient with COPD who reports increasing dyspnea at rest
D. A patient with hypertension scheduled for a medication refill
Correct Answer: C. A patient with COPD who reports increasing dyspnea at rest
Rationale: The ABC (Airway, Breathing, Circulation) framework mandates prioritizing airway and
breathing concerns above all else. Dyspnea at rest in a COPD patient indicates potential respiratory
compromise and requires immediate assessment. The other patients have stable, non-urgent needs that
can be addressed after the respiratory issue. Prioritization is a core QSEN competency and NGN clinical
judgment skill.
5. Which of the following are appropriate components of a nursing diagnosis statement?
(Select all that apply.)
A. A human response to a health condition or life process
B. A medical disease or pathology label
C. Related factors or risk factors
D. Defining characteristics or risk cues
E. A prescribed pharmacological treatment plan
Correct Answers: A, C, D
Rationale: A NANDA-I nursing diagnosis consists of: (1) the human response/health problem (e.g.,
Impaired Gas Exchange), (2) related factors or 'related to' statements (e.g., related to altered oxygen
2
, Galen NSG 4100 Exam 1 — Adult Health
supply), and (3) defining characteristics or risk cues that support the diagnosis. Medical diagnoses (B)
and treatment plans (E) are not components of nursing diagnoses; they belong to the medical domain
(Herdman & Kamitsuru, NANDA-I Nursing Diagnoses, 2021–2023).
6. A nurse is developing a care plan for a patient with acute pain following surgery. When
writing the nursing diagnosis, which format is MOST appropriate according to PES
(Problem, Etiology, Signs/Symptoms)?
A. Acute Pain related to surgical incision as evidenced by patient report of 8/10 on pain scale
B. Surgical Incision as evidenced by acute pain rated 8/10
C. Acute Pain due to postoperative status
D. Patient has pain because of surgery and reports 8/10
Correct Answer: A. Acute Pain related to surgical incision as evidenced by patient report of
8/10 on pain scale
Rationale: The PES format requires the Problem (Acute Pain), Etiology (related to surgical incision), and
Signs/Symptoms (as evidenced by patient report of 8/10). This three-part structure is the standard
NANDA-I approach for actual nursing diagnoses and ensures clarity, accuracy, and clinical relevance of
the diagnostic statement (Ignatavicius & Workman, Medical-Surgical Nursing, 2021).
SECTION II: FLUID, ELECTROLYTE, & ACID-BASE BALANCE
7. A nurse is assessing a client with a serum sodium level of 152 mEq/L. Which of the
following findings would the nurse EXPECT? (Select all that apply.)
A. Decreased skin turgor
B. Postural hypotension
C. Dry, sticky mucous membranes
D. Confusion and irritability
E. Bounding peripheral pulses
Correct Answers: C, D
Rationale: Hypernatremia (Na+ > 145 mEq/L) causes fluid to shift from cells to the extracellular space,
leading to cellular dehydration. Expected findings include dry mucous membranes, intense thirst,
confusion, irritability, and restlessness. Decreased skin turgor and postural hypotension are more typical
of volume depletion (which may accompany hypernatremia), while bounding pulses are associated with
fluid overload, not hypernatremia (Lewis et al., Medical-Surgical Nursing, 11th ed.).
8. A patient with heart failure is receiving furosemide (Lasix) 40 mg IV. The nurse should
monitor for which electrolyte imbalance that is MOST commonly associated with loop
diuretic therapy?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
3
GALEN COLLEGE OF NURSING
NSG 4100 – Nursing Practice: Adult Health — Exam 1 (2026/2027)
Instructions:
Total Questions: 60 (multiple-choice and select-all-that-apply) | Time Allowed: 2 hours | Passing Score:
75% (45/60)
For each question, select the single best answer unless otherwise indicated. SATA questions have multiple
correct responses.
Aligned with NGN (Next-Generation NCLEX) standards and QSEN competencies.
SECTION I: NURSING PROCESS & CLINICAL JUDGMENT
1. A nurse is caring for a client who was admitted with dehydration. Using the nursing
process, which action should the nurse perform FIRST?
A. Formulate a nursing diagnosis of Fluid Volume Deficit
B. Assess the client's vital signs, skin turgor, and urine output
C. Develop a plan of care for fluid replacement
D. Evaluate the client's response to IV fluid therapy
Correct Answer: B. Assess the client's vital signs, skin turgor, and urine output
Rationale: Assessment is the first step of the nursing process (ADPIE). The nurse must collect
comprehensive data before formulating a diagnosis, planning, implementing, or evaluating
interventions. Lewis's Medical-Surgical Nursing emphasizes that systematic assessment guides all
subsequent clinical decisions and is foundational to safe, patient-centered care.
2. According to Tanner's Clinical Judgment Model, which cognitive phase occurs when the
nurse notices that a postoperative patient's respiratory rate has increased from 16 to 28
breaths/min?
A. Interpreting
B. Responding
C. Noticing
D. Reflecting
Correct Answer: C. Noticing
Rationale: Tanner's model begins with Noticing — the nurse observes deviations from expected patterns.
Recognizing an elevated respiratory rate in a postoperative patient is an example of this initial phase.
1
, Galen NSG 4100 Exam 1 — Adult Health
Interpreting follows, where the nurse assigns meaning to the data. Responding involves choosing and
implementing interventions, and Reflecting evaluates the outcome of those interventions (Tanner, 2006).
3. A nurse is using the NCSBN Clinical Judgment Measurement Model (CJMM). After
recognizing cues that a patient may be developing sepsis, what is the NEXT step in the
model?
A. Generate solutions
B. Analyze cues
C. Take action
D. Evaluate outcomes
Correct Answer: B. Analyze cues
Rationale: The CJMM progresses from Recognize Cues → Analyze Cues → Prioritize Hypotheses →
Generate Solutions → Take Action → Evaluate Outcomes. After recognizing that a patient may have an
elevated temperature, heart rate, and altered mental status (potential sepsis cues), the nurse must
analyze these cues to determine their clinical significance before prioritizing hypotheses or taking action
(NCSBN, 2019).
4. The nurse receives morning report on four patients. Which patient should the nurse
assess FIRST based on the ABC prioritization framework?
A. A patient with type 2 diabetes requesting dietary education
B. A patient with a healed surgical wound awaiting discharge
C. A patient with COPD who reports increasing dyspnea at rest
D. A patient with hypertension scheduled for a medication refill
Correct Answer: C. A patient with COPD who reports increasing dyspnea at rest
Rationale: The ABC (Airway, Breathing, Circulation) framework mandates prioritizing airway and
breathing concerns above all else. Dyspnea at rest in a COPD patient indicates potential respiratory
compromise and requires immediate assessment. The other patients have stable, non-urgent needs that
can be addressed after the respiratory issue. Prioritization is a core QSEN competency and NGN clinical
judgment skill.
5. Which of the following are appropriate components of a nursing diagnosis statement?
(Select all that apply.)
A. A human response to a health condition or life process
B. A medical disease or pathology label
C. Related factors or risk factors
D. Defining characteristics or risk cues
E. A prescribed pharmacological treatment plan
Correct Answers: A, C, D
Rationale: A NANDA-I nursing diagnosis consists of: (1) the human response/health problem (e.g.,
Impaired Gas Exchange), (2) related factors or 'related to' statements (e.g., related to altered oxygen
2
, Galen NSG 4100 Exam 1 — Adult Health
supply), and (3) defining characteristics or risk cues that support the diagnosis. Medical diagnoses (B)
and treatment plans (E) are not components of nursing diagnoses; they belong to the medical domain
(Herdman & Kamitsuru, NANDA-I Nursing Diagnoses, 2021–2023).
6. A nurse is developing a care plan for a patient with acute pain following surgery. When
writing the nursing diagnosis, which format is MOST appropriate according to PES
(Problem, Etiology, Signs/Symptoms)?
A. Acute Pain related to surgical incision as evidenced by patient report of 8/10 on pain scale
B. Surgical Incision as evidenced by acute pain rated 8/10
C. Acute Pain due to postoperative status
D. Patient has pain because of surgery and reports 8/10
Correct Answer: A. Acute Pain related to surgical incision as evidenced by patient report of
8/10 on pain scale
Rationale: The PES format requires the Problem (Acute Pain), Etiology (related to surgical incision), and
Signs/Symptoms (as evidenced by patient report of 8/10). This three-part structure is the standard
NANDA-I approach for actual nursing diagnoses and ensures clarity, accuracy, and clinical relevance of
the diagnostic statement (Ignatavicius & Workman, Medical-Surgical Nursing, 2021).
SECTION II: FLUID, ELECTROLYTE, & ACID-BASE BALANCE
7. A nurse is assessing a client with a serum sodium level of 152 mEq/L. Which of the
following findings would the nurse EXPECT? (Select all that apply.)
A. Decreased skin turgor
B. Postural hypotension
C. Dry, sticky mucous membranes
D. Confusion and irritability
E. Bounding peripheral pulses
Correct Answers: C, D
Rationale: Hypernatremia (Na+ > 145 mEq/L) causes fluid to shift from cells to the extracellular space,
leading to cellular dehydration. Expected findings include dry mucous membranes, intense thirst,
confusion, irritability, and restlessness. Decreased skin turgor and postural hypotension are more typical
of volume depletion (which may accompany hypernatremia), while bounding pulses are associated with
fluid overload, not hypernatremia (Lewis et al., Medical-Surgical Nursing, 11th ed.).
8. A patient with heart failure is receiving furosemide (Lasix) 40 mg IV. The nurse should
monitor for which electrolyte imbalance that is MOST commonly associated with loop
diuretic therapy?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
3
