NSG 4800 COMPREHENSIVE EXAM 2026
Complete Practice Exam with Questions, Answers,
and Detailed Rationales
Question 1
The nurse is planning discharge for a client who had total parenteral nutrition (TPN) and now needs
crutches for mobility. Which referral is most appropriate?
A. Physical therapy referral
B. Occupational therapy referral
C. Social services referral
D. Home health aide referral
ANSWER: A
Rationale for ANSWER (A): Physical therapy (PT) is the appropriate referral for a client who needs
crutches. PT specialists are trained to assess mobility needs, teach proper crutch use, gait training, and
ensure safe ambulation techniques.
,
Rationale for InANSWERs:
B (Occupational therapy): OT focuses on activities of daily living (ADLs) and adaptive equipment for self-
care tasks, not primarily on mobility aids like crutches.
C (Social services): Social services helps with financial resources, discharge placement, and community
resources, not mobility training.
D (Home health aide): Home health aides assist with personal care and ADLs but are not qualified to
teach crutch walking or mobility techniques.
Question 2
A nurse is attending a continuing education program on legal issues in nursing practice. Which
statement by the nurse indicates understanding of negligence?
,A. "Failure to communicate concerns about a confused older adult client being discharged home is an
example of negligence"
B. "Documenting care after completing all tasks is the best practice"
C. "Following a physician's order protects me from all legal liability"
D. "Delegating tasks to UAP eliminates my responsibility"
ANSWER: A
Rationale for ANSWER (A): Negligence is the failure to act as a reasonably prudent nurse would in similar
circumstances. Failing to communicate concerns about a confused client's unsafe discharge
demonstrates a breach of the standard of care and could result in patient harm, meeting the criteria for
negligence.
,
Rationale for InANSWERs:
B (Documenting after care): While documentation is important, late documentation can be seen as less
credible and may not accurately reflect the care provided at the time.
C (Following orders): Nurses are still responsible for questioning inappropriate or unsafe orders;
following an obviously harmful order does not protect from liability.
D (Delegating eliminates responsibility): The nurse retains accountability for appropriate delegation and
supervision of delegated tasks.
Question 3
The nurse is working on a medical-surgical unit. Which task can be appropriately delegated to an LPN?
A. Obtaining a capillary blood glucose reading on a client who has become diaphoretic
B. Administering IV push medications
C. Developing a discharge teaching plan
D. Performing initial admission assessment
ANSWER: A
Rationale for ANSWER (A): Obtaining capillary blood glucose (BG) readings is within the LPN scope of
practice. This is a routine, stable client task that does not require the assessment and critical thinking
skills of an RN. LPNs can perform data collection on stable clients.
,
Rationale for InANSWERs:
B (IV push medications): IV push medications typically require RN-level training and assessment skills,
especially for unstable clients.
,C (Discharge teaching): Discharge planning and comprehensive teaching require RN-level assessment,
planning, and evaluation skills.
D (Initial assessment): Initial admission assessments require comprehensive nursing assessment skills
and clinical judgment that are within the RN scope, not LPN.
Question 4
The nurse is working on a pediatric unit caring for a 2-year-old with impaired fine and gross motor skills,
recently diagnosed with cerebral palsy. Which action should the nurse initiate?
A. Initiate an interdisciplinary conference
B. Refer to occupational therapy only
C. Schedule a neurology consult
D. Arrange for home health services immediately
ANSWER: A
Rationale for ANSWER (A): A child with cerebral palsy benefits from an interdisciplinary approach
involving physical therapy, occupational therapy, speech therapy, social services, nutrition, and medical
providers. An interdisciplinary conference ensures comprehensive, coordinated care addressing all
aspects of the child's developmental needs.
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Rationale for InANSWERs:
B (OT only): While OT is important, cerebral palsy affects multiple domains requiring a team approach,
not just one discipline.
C (Neurology consult): The diagnosis is already established; the child needs ongoing management and
therapy services rather than just medical consultation.
D (Home health immediately): Home health may be appropriate later, but first the child needs
comprehensive assessment and planning through interdisciplinary team collaboration.
Question 5
The nurse is receiving report on multiple clients. Which client should the nurse assess first?
A. Client with CAD receiving continuous heparin infusion with partial thromboplastin time (PTT) of 90
seconds
B. Client with diabetes needing morning insulin
C. Client scheduled for discharge in 2 hours
D. Client requesting pain medication for incisional pain rated 4/10
ANSWER: A
, Rationale for ANSWER (A): A PTT of 90 seconds is significantly elevated (therapeutic range is typically 46-
70 seconds or 1.5-2.5 times normal). This puts the client at high risk for bleeding complications. This is
an urgent situation requiring immediate assessment and likely heparin adjustment. Using ABCs and
safety priorities, this unstable client takes precedence.
,
Rationale for InANSWERs:
B (Morning insulin): While important, this is a routine medication that can be given within a reasonable
timeframe and the client is stable.
C (Discharge in 2 hours): Discharge teaching is important but not urgent compared to a potentially life-
threatening lab value.
D (Pain 4/10): A pain level of 4/10 is moderate and not an emergency; the client is stable.
Question 6
A client weighs 150 pounds and has developed encephalopathy with flaccidity in the lower extremities.
Which nursing intervention is the priority?
A. Implement fall precautions and bed alarm
B. Apply sequential compression devices
C. Encourage oral fluid intake
D. Administer scheduled analgesics
ANSWER: A
Rationale for ANSWER (A): A client with encephalopathy (altered mental status) and flaccidity is at
extremely high risk for falls and injury. Safety is always the priority. The combination of altered cognition
and inability to move lower extremities creates significant fall risk. Fall precautions including bed alarm
are essential.
,
Rationale for InANSWERs:
B (SCDs): While DVT prophylaxis is important for immobile clients, safety and preventing immediate
harm takes priority.
C (Oral fluids): A client with encephalopathy may have altered swallowing and aspiration risk; fluid
management requires assessment first.
D (Analgesics): Pain management is important but not the priority when the client has altered mental
status and safety risks.
Question 7
Complete Practice Exam with Questions, Answers,
and Detailed Rationales
Question 1
The nurse is planning discharge for a client who had total parenteral nutrition (TPN) and now needs
crutches for mobility. Which referral is most appropriate?
A. Physical therapy referral
B. Occupational therapy referral
C. Social services referral
D. Home health aide referral
ANSWER: A
Rationale for ANSWER (A): Physical therapy (PT) is the appropriate referral for a client who needs
crutches. PT specialists are trained to assess mobility needs, teach proper crutch use, gait training, and
ensure safe ambulation techniques.
,
Rationale for InANSWERs:
B (Occupational therapy): OT focuses on activities of daily living (ADLs) and adaptive equipment for self-
care tasks, not primarily on mobility aids like crutches.
C (Social services): Social services helps with financial resources, discharge placement, and community
resources, not mobility training.
D (Home health aide): Home health aides assist with personal care and ADLs but are not qualified to
teach crutch walking or mobility techniques.
Question 2
A nurse is attending a continuing education program on legal issues in nursing practice. Which
statement by the nurse indicates understanding of negligence?
,A. "Failure to communicate concerns about a confused older adult client being discharged home is an
example of negligence"
B. "Documenting care after completing all tasks is the best practice"
C. "Following a physician's order protects me from all legal liability"
D. "Delegating tasks to UAP eliminates my responsibility"
ANSWER: A
Rationale for ANSWER (A): Negligence is the failure to act as a reasonably prudent nurse would in similar
circumstances. Failing to communicate concerns about a confused client's unsafe discharge
demonstrates a breach of the standard of care and could result in patient harm, meeting the criteria for
negligence.
,
Rationale for InANSWERs:
B (Documenting after care): While documentation is important, late documentation can be seen as less
credible and may not accurately reflect the care provided at the time.
C (Following orders): Nurses are still responsible for questioning inappropriate or unsafe orders;
following an obviously harmful order does not protect from liability.
D (Delegating eliminates responsibility): The nurse retains accountability for appropriate delegation and
supervision of delegated tasks.
Question 3
The nurse is working on a medical-surgical unit. Which task can be appropriately delegated to an LPN?
A. Obtaining a capillary blood glucose reading on a client who has become diaphoretic
B. Administering IV push medications
C. Developing a discharge teaching plan
D. Performing initial admission assessment
ANSWER: A
Rationale for ANSWER (A): Obtaining capillary blood glucose (BG) readings is within the LPN scope of
practice. This is a routine, stable client task that does not require the assessment and critical thinking
skills of an RN. LPNs can perform data collection on stable clients.
,
Rationale for InANSWERs:
B (IV push medications): IV push medications typically require RN-level training and assessment skills,
especially for unstable clients.
,C (Discharge teaching): Discharge planning and comprehensive teaching require RN-level assessment,
planning, and evaluation skills.
D (Initial assessment): Initial admission assessments require comprehensive nursing assessment skills
and clinical judgment that are within the RN scope, not LPN.
Question 4
The nurse is working on a pediatric unit caring for a 2-year-old with impaired fine and gross motor skills,
recently diagnosed with cerebral palsy. Which action should the nurse initiate?
A. Initiate an interdisciplinary conference
B. Refer to occupational therapy only
C. Schedule a neurology consult
D. Arrange for home health services immediately
ANSWER: A
Rationale for ANSWER (A): A child with cerebral palsy benefits from an interdisciplinary approach
involving physical therapy, occupational therapy, speech therapy, social services, nutrition, and medical
providers. An interdisciplinary conference ensures comprehensive, coordinated care addressing all
aspects of the child's developmental needs.
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Rationale for InANSWERs:
B (OT only): While OT is important, cerebral palsy affects multiple domains requiring a team approach,
not just one discipline.
C (Neurology consult): The diagnosis is already established; the child needs ongoing management and
therapy services rather than just medical consultation.
D (Home health immediately): Home health may be appropriate later, but first the child needs
comprehensive assessment and planning through interdisciplinary team collaboration.
Question 5
The nurse is receiving report on multiple clients. Which client should the nurse assess first?
A. Client with CAD receiving continuous heparin infusion with partial thromboplastin time (PTT) of 90
seconds
B. Client with diabetes needing morning insulin
C. Client scheduled for discharge in 2 hours
D. Client requesting pain medication for incisional pain rated 4/10
ANSWER: A
, Rationale for ANSWER (A): A PTT of 90 seconds is significantly elevated (therapeutic range is typically 46-
70 seconds or 1.5-2.5 times normal). This puts the client at high risk for bleeding complications. This is
an urgent situation requiring immediate assessment and likely heparin adjustment. Using ABCs and
safety priorities, this unstable client takes precedence.
,
Rationale for InANSWERs:
B (Morning insulin): While important, this is a routine medication that can be given within a reasonable
timeframe and the client is stable.
C (Discharge in 2 hours): Discharge teaching is important but not urgent compared to a potentially life-
threatening lab value.
D (Pain 4/10): A pain level of 4/10 is moderate and not an emergency; the client is stable.
Question 6
A client weighs 150 pounds and has developed encephalopathy with flaccidity in the lower extremities.
Which nursing intervention is the priority?
A. Implement fall precautions and bed alarm
B. Apply sequential compression devices
C. Encourage oral fluid intake
D. Administer scheduled analgesics
ANSWER: A
Rationale for ANSWER (A): A client with encephalopathy (altered mental status) and flaccidity is at
extremely high risk for falls and injury. Safety is always the priority. The combination of altered cognition
and inability to move lower extremities creates significant fall risk. Fall precautions including bed alarm
are essential.
,
Rationale for InANSWERs:
B (SCDs): While DVT prophylaxis is important for immobile clients, safety and preventing immediate
harm takes priority.
C (Oral fluids): A client with encephalopathy may have altered swallowing and aspiration risk; fluid
management requires assessment first.
D (Analgesics): Pain management is important but not the priority when the client has altered mental
status and safety risks.
Question 7
