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NSG 4100&4800 | NSG 4100/4800 Comprehensive
Practice Examination
NSG 4100/4800 Comprehensive Practice Examination
Question 1: A nurse is caring for a patient who has fibromyalgia and reports pain at multiple tender
points, non-refreshing sleep, and depression. Which treatments should the nurse anticipate including in
the plan of care? (Select all that apply.)
• A. Minimal aerobic exercise
• B. Relaxation strategies, such as biofeedback
• C. Anti-seizure medication, such as phenytoin
• D. A selective serotonin reuptake inhibitor (SSRI), like sertraline
• E. Establishing a regular sleep pattern
Answer: B, D, E
Rationale: The management of fibromyalgia is multimodal, focusing on symptom management and
improving function. Evidence-based treatments include relaxation strategies (biofeedback), SSRIs to
address pain and depression, and establishing a regular sleep pattern to combat fatigue. High-intensity
exercise can worsen symptoms, and anti-seizure medications like pregabalin are used, but phenytoin is
not a first-line treatment for fibromyalgia.
Question 2: The nurse is caring for a client with a head injury. Which assessment finding is the earliest
sign of increased intracranial pressure (ICP)?
• A. Widening pulse pressure and bradycardia
• B. Projectile vomiting
• C. A change in the level of consciousness (LOC)
• D. Decerebrate posturing
Answer: C
Rationale: A change in the level of consciousness (e.g., restlessness, confusion, drowsiness) is the most
sensitive and earliest indicator of a change in neurological status and increasing ICP. Cushing's triad
(widening pulse pressure, bradycardia, and irregular respirations) is a very late and ominous sign.
,2
Question 3: A patient in the neurologic ICU has developed cerebral edema following an acute head
injury. The nurse anticipates administering which priority medication?
• A. Hydrochlorothiazide
• B. Furosemide (Lasix)
• C. Mannitol (Osmitrol)
• D. Spironolactone (Aldactone)
Answer: C
Rationale: Mannitol is an osmotic diuretic that is the gold standard for rapidly reducing cerebral edema
and lowering intracranial pressure (ICP). It works by drawing fluid from the brain tissue into the
intravascular space, where it can be excreted by the kidneys.
Question 4: A nurse is caring for a dying patient. The patient's spouse is at the bedside and states, "I
think he is choking to death." What is the nurse's most appropriate response?
• A. "Do not worry. The choking sound is normal during the dying process."
• B. "I will administer more morphine to keep your husband comfortable."
• C. "I can ask the respiratory therapist to suction secretions out through his nose."
• D. "I will have another nurse assist me to turn your husband on his side."
Answer: D
Rationale: The "death rattle" is caused by the accumulation of oral and respiratory secretions that the
patient can no longer clear. The best nursing intervention is to reposition the patient, often on their
side, to allow gravity to help drain the secretions. This is a non-pharmacological comfort measure that
addresses the family's immediate concern.
Question 5: A nurse manager observes that staff morale is low and nurses are leaving the unit at high
rates. Which leadership style is most appropriate to address this situation?
• A. Autocratic leadership
• B. Laissez-faire leadership
• C. Transactional leadership
• D. Transformational leadership
Answer: D
Rationale: Transformational leadership is the most effective style for improving morale and inspiring
change. It focuses on empowering and motivating staff by creating a shared vision, fostering a positive
work environment, and supporting individual growth. This is ideal for addressing high turnover and
burnout.
Question 6: A nurse is assessing a client's risk for suicide. Which of the following is the single most
important risk factor to assess?
,3
• A. A history of a major depressive disorder
• B. A previous suicide attempt
• C. Being an older adult
• D. Having a comorbid substance use disorder
Answer: B
Rationale: While all of these are significant risk factors, a history of a previous suicide attempt is the
single strongest predictor of future suicide attempts and completions. This is a critical part of the suicide
risk assessment using tools like the SAFE-T protocol.
Question 7: A nurse is caring for an older adult with dementia who has a history of falls. After placing
the client in a chair with a safety alarm, the alarm sounds. The nurse states, "I will need to put restraints
on you if you keep sounding the alarm." This statement by the nurse constitutes:
• A. Assault
• B. Battery
• C. False imprisonment
• D. Negligence
Answer: A
Rationale: Assault is the threat of unlawful physical contact that causes a person to fear harm. By
threatening to apply restraints, the nurse has placed the client in fear of being touched in a harmful or
offensive way. Battery is the actual, non-consensual physical contact itself.
Question 8: A nurse is preparing to care for a client who has returned to the nursing unit following a
cardiac catheterization performed through the femoral artery. Which assessment finding would require
immediate action by the nurse?
• A. The client reports pain at the insertion site rated 2 out of 10.
• B. The client's dressing has a small amount of dried blood.
• C. The client is experiencing numbness and tingling in the extremity.
• D. The client's blood pressure is 130/80 mmHg.
Answer: C
Rationale: Numbness and tingling in the affected extremity after a femoral catheterization could
indicate a developing hematoma compressing the femoral nerve or a thrombus impairing distal
circulation. This is a sign of a neurovascular compromise and requires immediate intervention to prevent
permanent damage.
Question 9: A client with hyperthyroidism is being discharged. Which statement by the client indicates a
need for further teaching?
• A. "I will take my medication at the same time every day."
, 4
• B. "I need to avoid crowded places and people who are sick."
• C. "I should report any signs of a sore throat or fever."
• D. "I can stop taking my medication once my symptoms improve."
Answer: D
Rationale: Medications for hyperthyroidism, such as methimazole or propylthiouracil (PTU), must be
taken consistently as prescribed. Stopping them abruptly, even if symptoms improve, can lead to a life-
threatening "thyroid storm." The other statements demonstrate correct understanding of medication
adherence and side effect management (agranulocytosis).
Question 10: A client is receiving a unit of packed red blood cells (PRBCs). The client experiences tingling
in the fingers and a sudden onset of chills. What is the nurse's priority action?
• A. Slow the rate of the infusion.
• B. Stop the transfusion immediately.
• C. Administer an antipyretic as ordered.
• D. Notify the blood bank.
Answer: B
Rationale: The first signs of a hemolytic transfusion reaction can include tingling, chills, fever, and a
sense of impending doom. The priority nursing action is to immediately stop the transfusion to prevent
further infusion of the incompatible blood. After stopping the transfusion, the nurse should maintain the
IV line with normal saline, notify the provider and blood bank, and monitor vital signs.
Question 11: A nurse is planning a community health program about suicide prevention. Using the
mnemonic "IS PATH WARM," the nurse should identify that the "P" stands for which of the following?
• A. Previous attempts
• B. Purposelessness
• C. Psychiatric illness
• D. Pain
Answer: B
Rationale: "IS PATH WARM" is a widely used mnemonic for the warning signs of suicide. The correct
components are: Ideation, Substance
use, Purposelessness, Anxiety, Trapped, Hopelessness, Withdrawal, Anger, Recklessness, and Mood
changes. It is a crucial tool for nurses to identify at-risk individuals.
Question 12: A client is prescribed donepezil for Alzheimer's disease. The client's family asks, "How does
this medication help?" Which response by the nurse is correct?
• A. "It cures Alzheimer's disease by stopping the progression of brain damage."
NSG 4100&4800 | NSG 4100/4800 Comprehensive
Practice Examination
NSG 4100/4800 Comprehensive Practice Examination
Question 1: A nurse is caring for a patient who has fibromyalgia and reports pain at multiple tender
points, non-refreshing sleep, and depression. Which treatments should the nurse anticipate including in
the plan of care? (Select all that apply.)
• A. Minimal aerobic exercise
• B. Relaxation strategies, such as biofeedback
• C. Anti-seizure medication, such as phenytoin
• D. A selective serotonin reuptake inhibitor (SSRI), like sertraline
• E. Establishing a regular sleep pattern
Answer: B, D, E
Rationale: The management of fibromyalgia is multimodal, focusing on symptom management and
improving function. Evidence-based treatments include relaxation strategies (biofeedback), SSRIs to
address pain and depression, and establishing a regular sleep pattern to combat fatigue. High-intensity
exercise can worsen symptoms, and anti-seizure medications like pregabalin are used, but phenytoin is
not a first-line treatment for fibromyalgia.
Question 2: The nurse is caring for a client with a head injury. Which assessment finding is the earliest
sign of increased intracranial pressure (ICP)?
• A. Widening pulse pressure and bradycardia
• B. Projectile vomiting
• C. A change in the level of consciousness (LOC)
• D. Decerebrate posturing
Answer: C
Rationale: A change in the level of consciousness (e.g., restlessness, confusion, drowsiness) is the most
sensitive and earliest indicator of a change in neurological status and increasing ICP. Cushing's triad
(widening pulse pressure, bradycardia, and irregular respirations) is a very late and ominous sign.
,2
Question 3: A patient in the neurologic ICU has developed cerebral edema following an acute head
injury. The nurse anticipates administering which priority medication?
• A. Hydrochlorothiazide
• B. Furosemide (Lasix)
• C. Mannitol (Osmitrol)
• D. Spironolactone (Aldactone)
Answer: C
Rationale: Mannitol is an osmotic diuretic that is the gold standard for rapidly reducing cerebral edema
and lowering intracranial pressure (ICP). It works by drawing fluid from the brain tissue into the
intravascular space, where it can be excreted by the kidneys.
Question 4: A nurse is caring for a dying patient. The patient's spouse is at the bedside and states, "I
think he is choking to death." What is the nurse's most appropriate response?
• A. "Do not worry. The choking sound is normal during the dying process."
• B. "I will administer more morphine to keep your husband comfortable."
• C. "I can ask the respiratory therapist to suction secretions out through his nose."
• D. "I will have another nurse assist me to turn your husband on his side."
Answer: D
Rationale: The "death rattle" is caused by the accumulation of oral and respiratory secretions that the
patient can no longer clear. The best nursing intervention is to reposition the patient, often on their
side, to allow gravity to help drain the secretions. This is a non-pharmacological comfort measure that
addresses the family's immediate concern.
Question 5: A nurse manager observes that staff morale is low and nurses are leaving the unit at high
rates. Which leadership style is most appropriate to address this situation?
• A. Autocratic leadership
• B. Laissez-faire leadership
• C. Transactional leadership
• D. Transformational leadership
Answer: D
Rationale: Transformational leadership is the most effective style for improving morale and inspiring
change. It focuses on empowering and motivating staff by creating a shared vision, fostering a positive
work environment, and supporting individual growth. This is ideal for addressing high turnover and
burnout.
Question 6: A nurse is assessing a client's risk for suicide. Which of the following is the single most
important risk factor to assess?
,3
• A. A history of a major depressive disorder
• B. A previous suicide attempt
• C. Being an older adult
• D. Having a comorbid substance use disorder
Answer: B
Rationale: While all of these are significant risk factors, a history of a previous suicide attempt is the
single strongest predictor of future suicide attempts and completions. This is a critical part of the suicide
risk assessment using tools like the SAFE-T protocol.
Question 7: A nurse is caring for an older adult with dementia who has a history of falls. After placing
the client in a chair with a safety alarm, the alarm sounds. The nurse states, "I will need to put restraints
on you if you keep sounding the alarm." This statement by the nurse constitutes:
• A. Assault
• B. Battery
• C. False imprisonment
• D. Negligence
Answer: A
Rationale: Assault is the threat of unlawful physical contact that causes a person to fear harm. By
threatening to apply restraints, the nurse has placed the client in fear of being touched in a harmful or
offensive way. Battery is the actual, non-consensual physical contact itself.
Question 8: A nurse is preparing to care for a client who has returned to the nursing unit following a
cardiac catheterization performed through the femoral artery. Which assessment finding would require
immediate action by the nurse?
• A. The client reports pain at the insertion site rated 2 out of 10.
• B. The client's dressing has a small amount of dried blood.
• C. The client is experiencing numbness and tingling in the extremity.
• D. The client's blood pressure is 130/80 mmHg.
Answer: C
Rationale: Numbness and tingling in the affected extremity after a femoral catheterization could
indicate a developing hematoma compressing the femoral nerve or a thrombus impairing distal
circulation. This is a sign of a neurovascular compromise and requires immediate intervention to prevent
permanent damage.
Question 9: A client with hyperthyroidism is being discharged. Which statement by the client indicates a
need for further teaching?
• A. "I will take my medication at the same time every day."
, 4
• B. "I need to avoid crowded places and people who are sick."
• C. "I should report any signs of a sore throat or fever."
• D. "I can stop taking my medication once my symptoms improve."
Answer: D
Rationale: Medications for hyperthyroidism, such as methimazole or propylthiouracil (PTU), must be
taken consistently as prescribed. Stopping them abruptly, even if symptoms improve, can lead to a life-
threatening "thyroid storm." The other statements demonstrate correct understanding of medication
adherence and side effect management (agranulocytosis).
Question 10: A client is receiving a unit of packed red blood cells (PRBCs). The client experiences tingling
in the fingers and a sudden onset of chills. What is the nurse's priority action?
• A. Slow the rate of the infusion.
• B. Stop the transfusion immediately.
• C. Administer an antipyretic as ordered.
• D. Notify the blood bank.
Answer: B
Rationale: The first signs of a hemolytic transfusion reaction can include tingling, chills, fever, and a
sense of impending doom. The priority nursing action is to immediately stop the transfusion to prevent
further infusion of the incompatible blood. After stopping the transfusion, the nurse should maintain the
IV line with normal saline, notify the provider and blood bank, and monitor vital signs.
Question 11: A nurse is planning a community health program about suicide prevention. Using the
mnemonic "IS PATH WARM," the nurse should identify that the "P" stands for which of the following?
• A. Previous attempts
• B. Purposelessness
• C. Psychiatric illness
• D. Pain
Answer: B
Rationale: "IS PATH WARM" is a widely used mnemonic for the warning signs of suicide. The correct
components are: Ideation, Substance
use, Purposelessness, Anxiety, Trapped, Hopelessness, Withdrawal, Anger, Recklessness, and Mood
changes. It is a crucial tool for nurses to identify at-risk individuals.
Question 12: A client is prescribed donepezil for Alzheimer's disease. The client's family asks, "How does
this medication help?" Which response by the nurse is correct?
• A. "It cures Alzheimer's disease by stopping the progression of brain damage."
