1
Galen NUR 283 Comp 1–3 Exams – Transition to
Registered Nursing Practice | (2026/2027) (PDF)
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Comp 1 – Questions 1–50
Q1. A nurse on a medical-surgical unit receives a hand-off report. Which client should the nurse assess
first?
A) A client with diabetes mellitus who has a blood glucose of 210 mg/dL
B) A client with pneumonia who has an oxygen saturation of 88% on room air ✅
C) A client with heart failure who has 1+ pitting edema in the lower extremities
D) A client with a hip fracture who is requesting pain medication
Rationale: The client with an O₂ saturation of 88% is hypoxemic and requires immediate intervention.
Airway and breathing take priority.
Q2. A client is receiving a blood transfusion. Fifteen minutes after initiation, the client reports low back
pain and chills. What is the priority action?
A) Administer acetaminophen
B) Slow the transfusion rate
C) Stop the transfusion ✅
D) Notify the healthcare provider
Rationale: Low back pain and chills are signs of a hemolytic transfusion reaction. The transfusion must
be stopped immediately.
Q3. A nurse is caring for a client with a nasogastric (NG) tube to low intermittent suction. The nurse
assesses the client and notes absent bowel sounds. Which action is most appropriate?
A) Irrigate the NG tube with 30 mL of normal saline
B) Notify the healthcare provider ✅
C) Increase the suction pressure
D) Reposition the client
Rationale: Absent bowel sounds after NG suction may indicate a paralytic ileus or bowel obstruction.
The provider should be notified.
Q4. A client with a history of opioid abuse is prescribed naloxone (Narcan). The nurse understands that
naloxone works by:
A) Competitively blocking opioid receptors ✅
B) Stimulating the central nervous system
C) Increasing the metabolism of opioids
D) Enhancing the effects of opioids
,3
Rationale: Naloxone is an opioid antagonist that reverses respiratory depression by binding to opioid
receptors without activating them.
Q5. The nurse is teaching a client with type 2 diabetes about metformin. Which statement indicates
understanding?
A) "I will take this medication on an empty stomach."
B) "I should take this medication with food to prevent stomach upset." ✅
C) "This medication will cause my blood sugar to drop too low."
D) "I can stop taking this medication when my blood sugar is normal."
Rationale: Metformin should be taken with meals to reduce gastrointestinal side effects. It rarely causes
hypoglycemia alone.
Q6. A nurse is preparing to administer a cleansing enema to a client. The client reports cramping during
the procedure. What is the appropriate action?
A) Continue the enema; cramping is expected
B) Slow the infusion rate ✅
C) Remove the tubing and stop the enema
D) Add more solution to the bag
Rationale: Slowing the flow rate reduces cramping. Stopping the enema may be necessary if severe, but
slowing is the first step.
Q7. A client with heart failure is prescribed furosemide (Lasix). Which finding indicates the medication is
effective?
A) Increased heart rate
B) Decreased crackles in the lungs ✅
C) Increased blood pressure
D) Weight gain of 2 kg in 24 hours
Rationale: Furosemide reduces fluid overload, improving pulmonary congestion and decreasing
crackles.
Q8. The nurse is caring for a client with a tracheostomy. Which action is most important to prevent a
pressure injury from the tracheostomy ties?
A) Clean the stoma daily with hydrogen peroxide
B) Place one finger between the tie and the neck ✅
C) Change the ties every shift
D) Use cotton ties instead of Velcro
Rationale: Leaving one finger's width of slack prevents excessive pressure on the skin.
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Q9. A client with chronic kidney disease has a potassium level of 6.5 mEq/L. Which ECG finding would
the nurse expect?
A) Flattened T waves
B) Peaked T waves ✅
C) Prolonged QT interval
D) Absent P waves
Rationale: Hyperkalemia causes tall, peaked T waves, widened QRS, and prolonged PR interval.
Q10. A nurse is assessing a client who is 1 day post-operative following a total hip arthroplasty. Which
finding requires immediate intervention?
A) Pain rated 4 on a scale of 0 to 10
B) Shortness of breath and chest pain ✅
C) Mild swelling of the operative leg
D) Temperature of 99.2°F (37.3°C)
Rationale: Shortness of breath and chest pain may indicate a pulmonary embolism, a life-threatening
complication after orthopedic surgery.
Q11. A client is prescribed enoxaparin (Lovenox) subcutaneously. The nurse should administer the
injection:
A) In the deltoid muscle
B) In the abdomen, without aspirating ✅
C) In the dorsogluteal muscle
D) With aspiration to check for blood return
Rationale: Enoxaparin is given subcutaneously in the abdomen; aspiration is not recommended because
it may cause bleeding.
Q12. The nurse is providing discharge teaching to a client with a new colostomy. Which statement
indicates understanding?
A) "I will change my pouch every day."
B) "I will empty my pouch when it is one-third to one-half full." ✅
C) "I will irrigate my colostomy every morning."
D) "I will avoid eating foods high in fiber."
Rationale: Emptying the pouch when one-third to one-half full prevents leakage and weight-related
pulling.
Galen NUR 283 Comp 1–3 Exams – Transition to
Registered Nursing Practice | (2026/2027) (PDF)
,2
Comp 1 – Questions 1–50
Q1. A nurse on a medical-surgical unit receives a hand-off report. Which client should the nurse assess
first?
A) A client with diabetes mellitus who has a blood glucose of 210 mg/dL
B) A client with pneumonia who has an oxygen saturation of 88% on room air ✅
C) A client with heart failure who has 1+ pitting edema in the lower extremities
D) A client with a hip fracture who is requesting pain medication
Rationale: The client with an O₂ saturation of 88% is hypoxemic and requires immediate intervention.
Airway and breathing take priority.
Q2. A client is receiving a blood transfusion. Fifteen minutes after initiation, the client reports low back
pain and chills. What is the priority action?
A) Administer acetaminophen
B) Slow the transfusion rate
C) Stop the transfusion ✅
D) Notify the healthcare provider
Rationale: Low back pain and chills are signs of a hemolytic transfusion reaction. The transfusion must
be stopped immediately.
Q3. A nurse is caring for a client with a nasogastric (NG) tube to low intermittent suction. The nurse
assesses the client and notes absent bowel sounds. Which action is most appropriate?
A) Irrigate the NG tube with 30 mL of normal saline
B) Notify the healthcare provider ✅
C) Increase the suction pressure
D) Reposition the client
Rationale: Absent bowel sounds after NG suction may indicate a paralytic ileus or bowel obstruction.
The provider should be notified.
Q4. A client with a history of opioid abuse is prescribed naloxone (Narcan). The nurse understands that
naloxone works by:
A) Competitively blocking opioid receptors ✅
B) Stimulating the central nervous system
C) Increasing the metabolism of opioids
D) Enhancing the effects of opioids
,3
Rationale: Naloxone is an opioid antagonist that reverses respiratory depression by binding to opioid
receptors without activating them.
Q5. The nurse is teaching a client with type 2 diabetes about metformin. Which statement indicates
understanding?
A) "I will take this medication on an empty stomach."
B) "I should take this medication with food to prevent stomach upset." ✅
C) "This medication will cause my blood sugar to drop too low."
D) "I can stop taking this medication when my blood sugar is normal."
Rationale: Metformin should be taken with meals to reduce gastrointestinal side effects. It rarely causes
hypoglycemia alone.
Q6. A nurse is preparing to administer a cleansing enema to a client. The client reports cramping during
the procedure. What is the appropriate action?
A) Continue the enema; cramping is expected
B) Slow the infusion rate ✅
C) Remove the tubing and stop the enema
D) Add more solution to the bag
Rationale: Slowing the flow rate reduces cramping. Stopping the enema may be necessary if severe, but
slowing is the first step.
Q7. A client with heart failure is prescribed furosemide (Lasix). Which finding indicates the medication is
effective?
A) Increased heart rate
B) Decreased crackles in the lungs ✅
C) Increased blood pressure
D) Weight gain of 2 kg in 24 hours
Rationale: Furosemide reduces fluid overload, improving pulmonary congestion and decreasing
crackles.
Q8. The nurse is caring for a client with a tracheostomy. Which action is most important to prevent a
pressure injury from the tracheostomy ties?
A) Clean the stoma daily with hydrogen peroxide
B) Place one finger between the tie and the neck ✅
C) Change the ties every shift
D) Use cotton ties instead of Velcro
Rationale: Leaving one finger's width of slack prevents excessive pressure on the skin.
, 4
Q9. A client with chronic kidney disease has a potassium level of 6.5 mEq/L. Which ECG finding would
the nurse expect?
A) Flattened T waves
B) Peaked T waves ✅
C) Prolonged QT interval
D) Absent P waves
Rationale: Hyperkalemia causes tall, peaked T waves, widened QRS, and prolonged PR interval.
Q10. A nurse is assessing a client who is 1 day post-operative following a total hip arthroplasty. Which
finding requires immediate intervention?
A) Pain rated 4 on a scale of 0 to 10
B) Shortness of breath and chest pain ✅
C) Mild swelling of the operative leg
D) Temperature of 99.2°F (37.3°C)
Rationale: Shortness of breath and chest pain may indicate a pulmonary embolism, a life-threatening
complication after orthopedic surgery.
Q11. A client is prescribed enoxaparin (Lovenox) subcutaneously. The nurse should administer the
injection:
A) In the deltoid muscle
B) In the abdomen, without aspirating ✅
C) In the dorsogluteal muscle
D) With aspiration to check for blood return
Rationale: Enoxaparin is given subcutaneously in the abdomen; aspiration is not recommended because
it may cause bleeding.
Q12. The nurse is providing discharge teaching to a client with a new colostomy. Which statement
indicates understanding?
A) "I will change my pouch every day."
B) "I will empty my pouch when it is one-third to one-half full." ✅
C) "I will irrigate my colostomy every morning."
D) "I will avoid eating foods high in fiber."
Rationale: Emptying the pouch when one-third to one-half full prevents leakage and weight-related
pulling.
