NSG 4800 Comprehensive Exam 2026
Practice Questions with ANSWERs and
Rationales
1. The nurse is assisting with discharge planning for assigned clients. Which of the following referrals is
appropriate for the nurse to make?
A. A social worker referral for a client who has diabetes mellitus (type 2) and has neuropathy.
B. A physical therapy (PT) referral for a client who had a total knee replacement (TKR) and needs
instruction on the use of a walker.
C. An occupational therapy (OT) referral for a client who had an amputation and requires long-term IV
antibiotics.
D. A speech therapy referral for a client who is scheduled to undergo an outpatient
esophagogastroduodenoscopy (EGD).
ANSWER: B
Rationale:
Option A is incorrect: While social workers can help with resources and support services, diabetes with
neuropathy primarily requires diabetes education, wound care consultation, or podiatry referral rather
than social work unless there are psychosocial or financial concerns identified.
Option B is correct: Physical therapy is the appropriate referral for a client who needs mobility training
and instruction on assistive devices such as walkers following orthopedic surgery like total knee
replacement. PTs specialize in gross motor skills, mobility, and gait training.
Option C is incorrect: Occupational therapy focuses on activities of daily living (ADLs) and fine motor
skills, not IV antibiotic administration. Long-term IV antibiotics would require home health nursing or
infusion therapy services, not OT.
Option D is incorrect: Speech therapy is indicated for swallowing disorders (dysphagia), speech
impairments, or communication disorders. An EGD is a diagnostic procedure and does not automatically
require speech therapy unless swallowing difficulties are identified.
2. The nurse has attended a continuing education program on legal issues in nursing practice. Which of
the following statements by the nurse indicates a correct understanding of the conference?
,A. "Failure to communicate concerns about an older adult client who is confused and is being discharged
home is an example of neglect."
B. "Giving clients false assurance about a health care condition or expected outcome is an example of
libel."
C. "Threatening to touch a client without the client's consent is an example of battery."
D. "Posting information about a client on social media without the client's permission is an example of
slander."
ANSWER: A
Rationale:
Option A is correct: Neglect is a form of malpractice that involves failure to provide appropriate care or
failure to act when action is needed. Failing to communicate concerns about an unsafe discharge for a
confused older adult constitutes neglect because the nurse failed to advocate for the client's safety.
Option B is incorrect: Giving false assurance is not libel. Libel is written defamation of character. False
assurance may be considered a form of misrepresentation but is not classified as libel.
Option C is incorrect: Threatening to touch a client without consent is assault, not battery. Battery is the
actual unlawful touching or physical contact without consent. Assault is the threat or attempt to cause
harm.
Option D is incorrect: Posting client information on social media without permission is a HIPAA violation
and breach of confidentiality, not slander. Slander is spoken defamation of character.
3. The nurse working in a medical-surgical unit is caring for assigned clients. Which of the following tasks
is appropriate to delegate?
A. Asking an unlicensed assistive personnel (UAP) to turn off the tube feeding for a client who is
receiving continuous tube feedings and is vomiting.
B. Asking a licensed practical nurse (LPN/VN) to obtain a capillary blood glucose reading on a client who
has become diaphoretic.
C. Asking an unlicensed assistive personnel (UAP) to flush the closed-wound drainage system (JP) drain
of a client who is 2 days postoperative from an open appendectomy.
D. Asking a licensed practical nurse (LPN/VN) to teach a client who has a newly created ileostomy how
to change the appliance.
ANSWER: B
Rationale:
Option A is incorrect: Turning off tube feedings for a vomiting client requires nursing assessment and
judgment. The nurse needs to assess the client, determine the cause of vomiting, and make decisions
about the feeding regimen. This should not be delegated to UAP.
,Option B is correct: Obtaining a capillary blood glucose reading is a routine, standardized procedure that
LPN/VNs are educated and licensed to perform. A diaphoretic client may be experiencing hypoglycemia,
and checking blood glucose is within the LPN/VN scope of practice.
Option C is incorrect: Flushing a closed-wound drainage system requires sterile technique and nursing
assessment. This is not within the scope of practice for UAP and should be performed by licensed
nursing staff.
Option D is incorrect: Teaching a client about a newly created ileostomy requires comprehensive
assessment, planning, and evaluation. Initial teaching about new ostomy care should be done by an RN,
preferably one with ostomy certification, not delegated to an LPN/VN.
4. The nurse working on the pediatric unit is caring for the following clients. It is most appropriate for
the nurse to initiate an interdisciplinary conference for a client who is:
A. 7 months old, has intussusception, is vomiting, has colicky abdominal pain, and is having jelly-like
stools.
B. 6 months old, has respiratory syncytial virus (RSV), is wheezing, and has copious nasal discharge.
C. 2 years old, has impaired fine and gross motor skills, and was just diagnosed with cerebral palsy.
D. 2 months old, has developmental dysplasia of the hip, unequal leg lengths, internal abduction of the
left hip, and asymmetry of the gluteal folds.
ANSWER: C
Rationale:
Option A is incorrect: Intussusception is an acute emergency requiring immediate medical intervention,
possibly reduction or surgery. While interdisciplinary care is important, the immediate need is acute
medical management, not a planned interdisciplinary conference.
Option B is incorrect: RSV with wheezing requires respiratory support and monitoring, but this is a
common pediatric condition with standard treatment protocols. An interdisciplinary conference is not
the priority.
Option C is correct: A new diagnosis of cerebral palsy in a 2-year-old with impaired motor skills requires
comprehensive, long-term interdisciplinary planning involving physical therapy, occupational therapy,
speech therapy, social work, nutrition, and possibly developmental pediatrics. This child will need
ongoing coordinated care throughout development, making an interdisciplinary conference most
appropriate.
Option D is incorrect: Developmental dysplasia of the hip requires orthopedic management, possibly
with a Pavlik harness or other interventions, but this is primarily managed by orthopedics with nursing
support. While interdisciplinary care is beneficial, it doesn't require the same level of comprehensive
interdisciplinary planning as cerebral palsy.
5. The nurse working on the medical-surgical unit is caring for assigned clients. The nurse should initially
assess the client who:
, A. Has pericarditis with a temperature (T) of 101.8°F and chest pain that is relieved when the client leans
forward.
B. Has atrial fibrillation (AFib) with a pulse (P) that varies from 110 to 140 and is refusing to take the
scheduled dose of warfarin.
C. Has status asthmaticus, had wheezing on inspiration and expiration upon admission 30 minutes ago,
received a nebulizer treatment, and now has vesicular breath sounds.
D. Had thoracic surgery 12 hours ago with a chest tube to water seal drainage and has drained 175 mL of
serosanguineous fluid in the past hour.
ANSWER: D
Rationale:
Option A is incorrect: While the client with pericarditis has fever and chest pain, the pain being relieved
by leaning forward is a classic finding in pericarditis (not a concerning change). This client is stable and
expected.
Option B is incorrect: The client with AFib has an elevated heart rate and is refusing medication, which
requires attention. However, this is not immediately life-threatening compared to other options. The
nurse should address this after more urgent situations.
Option C is incorrect: The client with status asthmaticus who now has vesicular (normal) breath sounds
after nebulizer treatment is showing improvement. This is a positive finding indicating the treatment is
working. This client can be assessed after more urgent situations.
Option D is correct: Chest tube drainage of 175 mL in one hour is excessive and may indicate
hemorrhage. Normal chest tube drainage should be less than 100 mL/hour. This finding requires
immediate assessment and notification of the provider as it could indicate postoperative bleeding, a life-
threatening complication.
6. The nurse is caring for a client who weighs 150 lbs (68 kg) and has developed hepatic encephalopathy.
It is a priority for the nurse to notify the primary health care provider (PHCP) if the client develops:
A. The development of flaccidity to the lower extremities.
B. An increase in urine output to 1,450 mL/day.
C. A change in pupil size from 7 to 5 mm.
D. An increase in alanine aminotransferase (ALT) levels.
ANSWER: A
Rationale:
Option A is correct: Development of flaccidity in a client with hepatic encephalopathy may indicate
progression to cerebral edema and increased intracranial pressure (ICP), which can lead to herniation
and death. This is a neurological emergency requiring immediate notification of the provider.
Practice Questions with ANSWERs and
Rationales
1. The nurse is assisting with discharge planning for assigned clients. Which of the following referrals is
appropriate for the nurse to make?
A. A social worker referral for a client who has diabetes mellitus (type 2) and has neuropathy.
B. A physical therapy (PT) referral for a client who had a total knee replacement (TKR) and needs
instruction on the use of a walker.
C. An occupational therapy (OT) referral for a client who had an amputation and requires long-term IV
antibiotics.
D. A speech therapy referral for a client who is scheduled to undergo an outpatient
esophagogastroduodenoscopy (EGD).
ANSWER: B
Rationale:
Option A is incorrect: While social workers can help with resources and support services, diabetes with
neuropathy primarily requires diabetes education, wound care consultation, or podiatry referral rather
than social work unless there are psychosocial or financial concerns identified.
Option B is correct: Physical therapy is the appropriate referral for a client who needs mobility training
and instruction on assistive devices such as walkers following orthopedic surgery like total knee
replacement. PTs specialize in gross motor skills, mobility, and gait training.
Option C is incorrect: Occupational therapy focuses on activities of daily living (ADLs) and fine motor
skills, not IV antibiotic administration. Long-term IV antibiotics would require home health nursing or
infusion therapy services, not OT.
Option D is incorrect: Speech therapy is indicated for swallowing disorders (dysphagia), speech
impairments, or communication disorders. An EGD is a diagnostic procedure and does not automatically
require speech therapy unless swallowing difficulties are identified.
2. The nurse has attended a continuing education program on legal issues in nursing practice. Which of
the following statements by the nurse indicates a correct understanding of the conference?
,A. "Failure to communicate concerns about an older adult client who is confused and is being discharged
home is an example of neglect."
B. "Giving clients false assurance about a health care condition or expected outcome is an example of
libel."
C. "Threatening to touch a client without the client's consent is an example of battery."
D. "Posting information about a client on social media without the client's permission is an example of
slander."
ANSWER: A
Rationale:
Option A is correct: Neglect is a form of malpractice that involves failure to provide appropriate care or
failure to act when action is needed. Failing to communicate concerns about an unsafe discharge for a
confused older adult constitutes neglect because the nurse failed to advocate for the client's safety.
Option B is incorrect: Giving false assurance is not libel. Libel is written defamation of character. False
assurance may be considered a form of misrepresentation but is not classified as libel.
Option C is incorrect: Threatening to touch a client without consent is assault, not battery. Battery is the
actual unlawful touching or physical contact without consent. Assault is the threat or attempt to cause
harm.
Option D is incorrect: Posting client information on social media without permission is a HIPAA violation
and breach of confidentiality, not slander. Slander is spoken defamation of character.
3. The nurse working in a medical-surgical unit is caring for assigned clients. Which of the following tasks
is appropriate to delegate?
A. Asking an unlicensed assistive personnel (UAP) to turn off the tube feeding for a client who is
receiving continuous tube feedings and is vomiting.
B. Asking a licensed practical nurse (LPN/VN) to obtain a capillary blood glucose reading on a client who
has become diaphoretic.
C. Asking an unlicensed assistive personnel (UAP) to flush the closed-wound drainage system (JP) drain
of a client who is 2 days postoperative from an open appendectomy.
D. Asking a licensed practical nurse (LPN/VN) to teach a client who has a newly created ileostomy how
to change the appliance.
ANSWER: B
Rationale:
Option A is incorrect: Turning off tube feedings for a vomiting client requires nursing assessment and
judgment. The nurse needs to assess the client, determine the cause of vomiting, and make decisions
about the feeding regimen. This should not be delegated to UAP.
,Option B is correct: Obtaining a capillary blood glucose reading is a routine, standardized procedure that
LPN/VNs are educated and licensed to perform. A diaphoretic client may be experiencing hypoglycemia,
and checking blood glucose is within the LPN/VN scope of practice.
Option C is incorrect: Flushing a closed-wound drainage system requires sterile technique and nursing
assessment. This is not within the scope of practice for UAP and should be performed by licensed
nursing staff.
Option D is incorrect: Teaching a client about a newly created ileostomy requires comprehensive
assessment, planning, and evaluation. Initial teaching about new ostomy care should be done by an RN,
preferably one with ostomy certification, not delegated to an LPN/VN.
4. The nurse working on the pediatric unit is caring for the following clients. It is most appropriate for
the nurse to initiate an interdisciplinary conference for a client who is:
A. 7 months old, has intussusception, is vomiting, has colicky abdominal pain, and is having jelly-like
stools.
B. 6 months old, has respiratory syncytial virus (RSV), is wheezing, and has copious nasal discharge.
C. 2 years old, has impaired fine and gross motor skills, and was just diagnosed with cerebral palsy.
D. 2 months old, has developmental dysplasia of the hip, unequal leg lengths, internal abduction of the
left hip, and asymmetry of the gluteal folds.
ANSWER: C
Rationale:
Option A is incorrect: Intussusception is an acute emergency requiring immediate medical intervention,
possibly reduction or surgery. While interdisciplinary care is important, the immediate need is acute
medical management, not a planned interdisciplinary conference.
Option B is incorrect: RSV with wheezing requires respiratory support and monitoring, but this is a
common pediatric condition with standard treatment protocols. An interdisciplinary conference is not
the priority.
Option C is correct: A new diagnosis of cerebral palsy in a 2-year-old with impaired motor skills requires
comprehensive, long-term interdisciplinary planning involving physical therapy, occupational therapy,
speech therapy, social work, nutrition, and possibly developmental pediatrics. This child will need
ongoing coordinated care throughout development, making an interdisciplinary conference most
appropriate.
Option D is incorrect: Developmental dysplasia of the hip requires orthopedic management, possibly
with a Pavlik harness or other interventions, but this is primarily managed by orthopedics with nursing
support. While interdisciplinary care is beneficial, it doesn't require the same level of comprehensive
interdisciplinary planning as cerebral palsy.
5. The nurse working on the medical-surgical unit is caring for assigned clients. The nurse should initially
assess the client who:
, A. Has pericarditis with a temperature (T) of 101.8°F and chest pain that is relieved when the client leans
forward.
B. Has atrial fibrillation (AFib) with a pulse (P) that varies from 110 to 140 and is refusing to take the
scheduled dose of warfarin.
C. Has status asthmaticus, had wheezing on inspiration and expiration upon admission 30 minutes ago,
received a nebulizer treatment, and now has vesicular breath sounds.
D. Had thoracic surgery 12 hours ago with a chest tube to water seal drainage and has drained 175 mL of
serosanguineous fluid in the past hour.
ANSWER: D
Rationale:
Option A is incorrect: While the client with pericarditis has fever and chest pain, the pain being relieved
by leaning forward is a classic finding in pericarditis (not a concerning change). This client is stable and
expected.
Option B is incorrect: The client with AFib has an elevated heart rate and is refusing medication, which
requires attention. However, this is not immediately life-threatening compared to other options. The
nurse should address this after more urgent situations.
Option C is incorrect: The client with status asthmaticus who now has vesicular (normal) breath sounds
after nebulizer treatment is showing improvement. This is a positive finding indicating the treatment is
working. This client can be assessed after more urgent situations.
Option D is correct: Chest tube drainage of 175 mL in one hour is excessive and may indicate
hemorrhage. Normal chest tube drainage should be less than 100 mL/hour. This finding requires
immediate assessment and notification of the provider as it could indicate postoperative bleeding, a life-
threatening complication.
6. The nurse is caring for a client who weighs 150 lbs (68 kg) and has developed hepatic encephalopathy.
It is a priority for the nurse to notify the primary health care provider (PHCP) if the client develops:
A. The development of flaccidity to the lower extremities.
B. An increase in urine output to 1,450 mL/day.
C. A change in pupil size from 7 to 5 mm.
D. An increase in alanine aminotransferase (ALT) levels.
ANSWER: A
Rationale:
Option A is correct: Development of flaccidity in a client with hepatic encephalopathy may indicate
progression to cerebral edema and increased intracranial pressure (ICP), which can lead to herniation
and death. This is a neurological emergency requiring immediate notification of the provider.
