NSG 3800 All Exams Binder 2026 – Galen College of
Nursing (U.S.) | Complete Course Review & Verified
Answers | Comprehensive Nursing Assessment
Q001: A 68-year-old male with a history of type 2 diabetes, hypertension, and coronary
artery disease presents to the emergency department with crushing chest pain radiating
to his left jaw and arm that began while shoveling snow 2 hours ago. He is diaphoretic
and anxious. Vital signs: BP 178/98 mmHg, HR 104 bpm (regular), RR 22/min, O2 sat
92% on 2L nasal cannula. The 12-lead ECG shows ST-segment elevation in leads II, III,
and aVF with reciprocal changes in I and aVL. Troponin I is pending. The emergency
physician has activated the cath lab. Which intervention should the nurse implement
first?
Options:
A. Administer sublingual nitroglycerin 0.4 mg every 5 minutes x 3 doses
B. Give morphine sulfate 4 mg IV push for pain relief
C. Initiate anticoagulation with heparin bolus 60 units/kg IV - CORRECT
D. Start a beta-blocker such as metoprolol 5 mg IV to reduce myocardial oxygen
demand
(Correct Answer: C)
Q002: A 72-year-old female with chronic heart failure (EF 30%), atrial fibrillation, and
chronic kidney disease stage 3 presents with a 5-day history of worsening dyspnea,
orthopnea, and bilateral leg swelling. She reports a 10-pound weight gain. Vital signs:
BP 142/88 mmHg, HR 92 bpm (irregularly irregular), RR 24/min, O2 sat 89% on 2L.
Physical exam reveals JVD at 8 cm, bibasilar crackles, and 3+ pitting edema to the
knees. BNP is 1,250 pg/mL. Current medications include digoxin 0.125 mg daily,
furosemide 40 mg PO daily, and warfarin 5 mg daily. Which medication adjustment is
most critical for this acute decompensation?
Options:
A. Increase digoxin dose to improve contractility
B. Hold warfarin due to risk of bleeding with acute illness
C. Increase furosemide to 80 mg IV push twice daily - CORRECT
D. Start a beta-blocker immediately
(Correct Answer: C)
,Q003: A 45-year-old male with a history of schizophrenia, currently on haloperidol 10 mg
daily, is admitted to the medical-surgical unit for pneumonia. On day 2, his temperature
spikes to 103.2°F, BP 160/95 mmHg, HR 110 bpm, and he develops severe muscle
rigidity, diaphoresis, and altered mental status. CK is elevated at 2,850 U/L. WBC is
15,000. He is diagnosed with neuroleptic malignant syndrome (NMS). Which
intervention is the priority?
Options:
A. Administer dantrolene 2.5 mg/kg IV immediately - CORRECT
B. Give haloperidol 5 mg IM PRN for agitation
C. Start propranolol to control hypertension and tachycardia
D. Initiate cooling blanket therapy only
(Correct Answer: A)
Q004: A 32-year-old G2P1 at 38 weeks gestation presents to labor and delivery
complaining of decreased fetal movement for 24 hours and a severe headache that
started 2 hours ago. Vital signs: BP 165/105 mmHg, HR 88 bpm, RR 16/min. Urine dip
shows 3+ protein. The fetal heart rate tracing shows recurrent late decelerations with
minimal variability. The obstetrician diagnoses severe preeclampsia with non-reassuring
fetal status. Which intervention should the nurse prepare for immediately?
Options:
A. Start magnesium sulfate 4-6 g IV loading dose - CORRECT
B. Administer labetalol 20 mg IV to control blood pressure
C. Give terbutaline 0.25 mg SQ to stop contractions
D. Prepare for vaginal delivery with immediate pushing
(Correct Answer: A)
Q005: A 6-year-old child with a history of asthma is brought to the pediatric emergency
department with severe respiratory distress after exposure to cat dander. He is sitting
upright, using accessory muscles, and can only speak in 1-2 word phrases. Auscultation
reveals minimal air movement with no wheezing. O2 sat is 88% on room air. Peak flow is
40% of personal best. Which medication should be administered first?
Options:
A. Albuterol 2.5 mg nebulizer treatment
B. Ipratropium bromide 0.5 mg nebulizer
C. Methylprednisolone 2 mg/kg IV
D. Epinephrine 1:1000 0.01 mg/kg IM - CORRECT
(Correct Answer: D)
,Q006: A 78-year-old male with Alzheimer's dementia, hypertension, and osteoarthritis is
admitted from a long-term care facility for pneumonia. On night shift, he becomes
increasingly agitated, confused, and attempts to remove his IV. He is pulling at his bed
linens and calling out. The physician orders haloperidol 2 mg IM PRN for agitation.
Which intervention should the nurse implement first?
Options:
A. Administer haloperidol 2 mg IM as ordered
B. Apply soft wrist restraints to prevent IV removal
C. Assess for underlying causes of delirium (pain, urinary retention, hypoxia) - CORRECT
D. Move the patient to a private room near the nurse's station
(Correct Answer: C)
Q007: A 28-year-old female with a history of IV drug use presents to the ED with fever,
chills, and back pain. Vital signs: Temp 102.8°F, BP 94/58 mmHg, HR 128 bpm, RR
24/min. She has track marks on both arms. Blood cultures are drawn and show
gram-positive cocci in clusters. The physician suspects infective endocarditis. Which
intervention is the priority?
Options:
A. Administer vancomycin 1 g IV after cultures are obtained - CORRECT
B. Start nafcillin 2 g IV every 4 hours empirically
C. Obtain a transesophageal echocardiogram immediately
D. Give ibuprofen 600 mg for fever
(Correct Answer: A)
Q008: A 55-year-old female with type 1 diabetes for 25 years presents with nausea,
vomiting, abdominal pain, and confusion. Her blood glucose is 650 mg/dL, serum
osmolality is 340 mOsm/kg, pH is 7.30, bicarbonate is 15 mEq/L, and ketones are
positive. The physician diagnoses hyperglycemic hyperosmolar state (HHS) with mild
DKA. Which fluid resuscitation order is most appropriate initially?
Options:
A. 0.9% NS 1 L bolus then switch to 0.45% NS - CORRECT
B. D5W at 250 mL/hr
C. Lactated Ringer's 500 mL/hr
D. 0.45% NS bolus 2L
(Correct Answer: A)
Q009: A 40-year-old G3P2 at 28 weeks gestation presents to the antepartum clinic for a
routine visit. She reports feeling anxious and having difficulty sleeping for the past 6
, weeks. She scores 16 on the PHQ-9, indicating moderate depression. She has a history
of postpartum depression after her last pregnancy. Which intervention is most
appropriate?
Options:
A. Start sertraline 50 mg daily and refer to perinatal mental health specialist - CORRECT
B. Recommend St. John's wort and increased exercise
C. Wait until postpartum to start medication
D. Prescribe alprazolam 0.25 mg PRN for anxiety
(Correct Answer: A)
Q010: A 65-year-old male with end-stage COPD (FEV1 25% predicted) on home oxygen
2L presents with acute respiratory failure. He is intubated and on mechanical
ventilation. After 48 hours, he fails spontaneous breathing trials due to weakness and
hypercapnia. The multidisciplinary team discusses tracheostomy placement. Which
factor is most important in the decision-making process?
Options:
A. Patient's prior expressed wishes about quality of life and prolonged mechanical
ventilation - CORRECT
B. Family's request for full code status
C. Insurance coverage for long-term care facility
D. Provider's preference for early trach
(Correct Answer: A)
Q011: A 50-year-old male with schizophrenia, currently on clozapine 400 mg daily,
presents with fever 101.4°F, sore throat, and fatigue. WBC count is 2,800 cells/mm³ with
absolute neutrophil count of 1,200. The psychiatrist suspects clozapine-induced
neutropenia. Which action is required immediately?
Options:
A. Stop clozapine immediately and notify prescriber - CORRECT
B. Continue clozapine and recheck CBC in 1 week
C. Reduce clozapine dose by 50%
D. Start filgrastim and continue clozapine
(Correct Answer: A)
Q012: A 35-year-old female with a history of bipolar disorder on lithium 900 mg BID
presents with nausea, vomiting, diarrhea, and tremor. She has had a viral illness with
poor PO intake for 3 days. Her lithium level is 2.0 mEq/L (therapeutic range 0.6-1.2). The
physician diagnoses acute lithium toxicity. Which intervention is the priority?
Nursing (U.S.) | Complete Course Review & Verified
Answers | Comprehensive Nursing Assessment
Q001: A 68-year-old male with a history of type 2 diabetes, hypertension, and coronary
artery disease presents to the emergency department with crushing chest pain radiating
to his left jaw and arm that began while shoveling snow 2 hours ago. He is diaphoretic
and anxious. Vital signs: BP 178/98 mmHg, HR 104 bpm (regular), RR 22/min, O2 sat
92% on 2L nasal cannula. The 12-lead ECG shows ST-segment elevation in leads II, III,
and aVF with reciprocal changes in I and aVL. Troponin I is pending. The emergency
physician has activated the cath lab. Which intervention should the nurse implement
first?
Options:
A. Administer sublingual nitroglycerin 0.4 mg every 5 minutes x 3 doses
B. Give morphine sulfate 4 mg IV push for pain relief
C. Initiate anticoagulation with heparin bolus 60 units/kg IV - CORRECT
D. Start a beta-blocker such as metoprolol 5 mg IV to reduce myocardial oxygen
demand
(Correct Answer: C)
Q002: A 72-year-old female with chronic heart failure (EF 30%), atrial fibrillation, and
chronic kidney disease stage 3 presents with a 5-day history of worsening dyspnea,
orthopnea, and bilateral leg swelling. She reports a 10-pound weight gain. Vital signs:
BP 142/88 mmHg, HR 92 bpm (irregularly irregular), RR 24/min, O2 sat 89% on 2L.
Physical exam reveals JVD at 8 cm, bibasilar crackles, and 3+ pitting edema to the
knees. BNP is 1,250 pg/mL. Current medications include digoxin 0.125 mg daily,
furosemide 40 mg PO daily, and warfarin 5 mg daily. Which medication adjustment is
most critical for this acute decompensation?
Options:
A. Increase digoxin dose to improve contractility
B. Hold warfarin due to risk of bleeding with acute illness
C. Increase furosemide to 80 mg IV push twice daily - CORRECT
D. Start a beta-blocker immediately
(Correct Answer: C)
,Q003: A 45-year-old male with a history of schizophrenia, currently on haloperidol 10 mg
daily, is admitted to the medical-surgical unit for pneumonia. On day 2, his temperature
spikes to 103.2°F, BP 160/95 mmHg, HR 110 bpm, and he develops severe muscle
rigidity, diaphoresis, and altered mental status. CK is elevated at 2,850 U/L. WBC is
15,000. He is diagnosed with neuroleptic malignant syndrome (NMS). Which
intervention is the priority?
Options:
A. Administer dantrolene 2.5 mg/kg IV immediately - CORRECT
B. Give haloperidol 5 mg IM PRN for agitation
C. Start propranolol to control hypertension and tachycardia
D. Initiate cooling blanket therapy only
(Correct Answer: A)
Q004: A 32-year-old G2P1 at 38 weeks gestation presents to labor and delivery
complaining of decreased fetal movement for 24 hours and a severe headache that
started 2 hours ago. Vital signs: BP 165/105 mmHg, HR 88 bpm, RR 16/min. Urine dip
shows 3+ protein. The fetal heart rate tracing shows recurrent late decelerations with
minimal variability. The obstetrician diagnoses severe preeclampsia with non-reassuring
fetal status. Which intervention should the nurse prepare for immediately?
Options:
A. Start magnesium sulfate 4-6 g IV loading dose - CORRECT
B. Administer labetalol 20 mg IV to control blood pressure
C. Give terbutaline 0.25 mg SQ to stop contractions
D. Prepare for vaginal delivery with immediate pushing
(Correct Answer: A)
Q005: A 6-year-old child with a history of asthma is brought to the pediatric emergency
department with severe respiratory distress after exposure to cat dander. He is sitting
upright, using accessory muscles, and can only speak in 1-2 word phrases. Auscultation
reveals minimal air movement with no wheezing. O2 sat is 88% on room air. Peak flow is
40% of personal best. Which medication should be administered first?
Options:
A. Albuterol 2.5 mg nebulizer treatment
B. Ipratropium bromide 0.5 mg nebulizer
C. Methylprednisolone 2 mg/kg IV
D. Epinephrine 1:1000 0.01 mg/kg IM - CORRECT
(Correct Answer: D)
,Q006: A 78-year-old male with Alzheimer's dementia, hypertension, and osteoarthritis is
admitted from a long-term care facility for pneumonia. On night shift, he becomes
increasingly agitated, confused, and attempts to remove his IV. He is pulling at his bed
linens and calling out. The physician orders haloperidol 2 mg IM PRN for agitation.
Which intervention should the nurse implement first?
Options:
A. Administer haloperidol 2 mg IM as ordered
B. Apply soft wrist restraints to prevent IV removal
C. Assess for underlying causes of delirium (pain, urinary retention, hypoxia) - CORRECT
D. Move the patient to a private room near the nurse's station
(Correct Answer: C)
Q007: A 28-year-old female with a history of IV drug use presents to the ED with fever,
chills, and back pain. Vital signs: Temp 102.8°F, BP 94/58 mmHg, HR 128 bpm, RR
24/min. She has track marks on both arms. Blood cultures are drawn and show
gram-positive cocci in clusters. The physician suspects infective endocarditis. Which
intervention is the priority?
Options:
A. Administer vancomycin 1 g IV after cultures are obtained - CORRECT
B. Start nafcillin 2 g IV every 4 hours empirically
C. Obtain a transesophageal echocardiogram immediately
D. Give ibuprofen 600 mg for fever
(Correct Answer: A)
Q008: A 55-year-old female with type 1 diabetes for 25 years presents with nausea,
vomiting, abdominal pain, and confusion. Her blood glucose is 650 mg/dL, serum
osmolality is 340 mOsm/kg, pH is 7.30, bicarbonate is 15 mEq/L, and ketones are
positive. The physician diagnoses hyperglycemic hyperosmolar state (HHS) with mild
DKA. Which fluid resuscitation order is most appropriate initially?
Options:
A. 0.9% NS 1 L bolus then switch to 0.45% NS - CORRECT
B. D5W at 250 mL/hr
C. Lactated Ringer's 500 mL/hr
D. 0.45% NS bolus 2L
(Correct Answer: A)
Q009: A 40-year-old G3P2 at 28 weeks gestation presents to the antepartum clinic for a
routine visit. She reports feeling anxious and having difficulty sleeping for the past 6
, weeks. She scores 16 on the PHQ-9, indicating moderate depression. She has a history
of postpartum depression after her last pregnancy. Which intervention is most
appropriate?
Options:
A. Start sertraline 50 mg daily and refer to perinatal mental health specialist - CORRECT
B. Recommend St. John's wort and increased exercise
C. Wait until postpartum to start medication
D. Prescribe alprazolam 0.25 mg PRN for anxiety
(Correct Answer: A)
Q010: A 65-year-old male with end-stage COPD (FEV1 25% predicted) on home oxygen
2L presents with acute respiratory failure. He is intubated and on mechanical
ventilation. After 48 hours, he fails spontaneous breathing trials due to weakness and
hypercapnia. The multidisciplinary team discusses tracheostomy placement. Which
factor is most important in the decision-making process?
Options:
A. Patient's prior expressed wishes about quality of life and prolonged mechanical
ventilation - CORRECT
B. Family's request for full code status
C. Insurance coverage for long-term care facility
D. Provider's preference for early trach
(Correct Answer: A)
Q011: A 50-year-old male with schizophrenia, currently on clozapine 400 mg daily,
presents with fever 101.4°F, sore throat, and fatigue. WBC count is 2,800 cells/mm³ with
absolute neutrophil count of 1,200. The psychiatrist suspects clozapine-induced
neutropenia. Which action is required immediately?
Options:
A. Stop clozapine immediately and notify prescriber - CORRECT
B. Continue clozapine and recheck CBC in 1 week
C. Reduce clozapine dose by 50%
D. Start filgrastim and continue clozapine
(Correct Answer: A)
Q012: A 35-year-old female with a history of bipolar disorder on lithium 900 mg BID
presents with nausea, vomiting, diarrhea, and tremor. She has had a viral illness with
poor PO intake for 3 days. Her lithium level is 2.0 mEq/L (therapeutic range 0.6-1.2). The
physician diagnoses acute lithium toxicity. Which intervention is the priority?
