NSG 4800 COMPREHENSIVE EXAM
Complete Practice Exam with ANSWERs and
Rationales 2026
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 physical therapy referral for a client who had total knee replacement (TKR) and needs use of a
walker.
CORRECT ANSWER
Rationale: This is appropriate because physical therapy specializes in mobility training, gait training, and
teaching proper use of assistive devices like walkers after orthopedic surgeries such as total knee
replacement.
b. A speech therapy referral for a client who is scheduled to undergo an outpatient
esophagogastroduodenoscopy (EGD).
INCORRECT
Rationale: Speech therapy is not indicated for EGD procedures. Speech therapy addresses swallowing
disorders, speech impairments, and communication issues. An EGD is a diagnostic procedure that does
not typically require speech therapy involvement.
c. An occupational therapy (OT) referral for a client who had an amputation and requires long term IV
antibiotics.
INCORRECT
Rationale: Long-term IV antibiotics require home health nursing or infusion services, not occupational
therapy. OT focuses on activities of daily living (ADLs), adaptive equipment, and functional
independence, not medication administration.
d. A social worker referral for a client who has diabetes mellitus (type 2) and has developed neuropathy.
INCORRECT
Rationale: While social workers can help with diabetes management resources, neuropathy itself does
not automatically require social work involvement. This client would benefit more from diabetes
education, podiatry referral, or wound care if ulcers are present.
,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. "Threatening to touch a client without the client's consent is an example of battery."
INCORRECT
Rationale: Threatening to touch without consent is assault, not battery. Battery is the actual unwanted
touching or physical contact. Assault is the threat or attempt to cause harmful or offensive contact.
b. "Failure to communicate concerns of an older adult client who is confused and is being discharged
home is an example of negligence."
CORRECT ANSWER
Rationale: Negligence is the failure to act as a reasonably prudent nurse would in similar circumstances.
Failing to communicate important patient concerns that could affect patient safety constitutes
negligence and breach of the standard of care.
c. "Giving clients false assurance about a healthcare condition or expected outcome is an example of
libel."
INCORRECT
Rationale: False assurance is not libel. Libel is a false written statement that damages someone's
reputation. Giving false assurance may be considered unethical practice or potentially fraud, but it is not
libel.
d. "Posting information about a client on social media without the client's permission is an example of
slander."
INCORRECT
Rationale: Posting client information without permission is a HIPAA violation and breach of
confidentiality, not slander. Slander is spoken defamation. This action could also be considered libel if
written, but the primary issue is privacy violation.
3. The nurse working in a medical surgical unit is caring for assigned clients. Which of the following tests
is appropriate to delegate?
a. Asking a licensed practical nurse to teach a client who has a newly created ileostomy how to change
the appliance.
INCORRECT
Rationale: Teaching new ostomy care should not be delegated to an LPN. Initial teaching of complex
new procedures, especially those requiring comprehensive assessment and evaluation of learning,
should be performed by the RN. LPNs can reinforce teaching already provided by the RN.
b. Asking a licensed practical nurse to obtain a capillary blood glucose reading on a client who has
become diaphoretic.
,CORRECT ANSWER
Rationale: This is appropriate delegation. LPNs can perform routine, standardized procedures like blood
glucose monitoring. This is within their scope of practice and does not require the assessment and
judgment skills of an RN.
c. Asking a UAP to flush the closed wound drainage system of a client who is two days postoperative
from an open appendectomy.
INCORRECT
Rationale: UAPs (Unlicensed Assistive Personnel) should not flush wound drainage systems. This is a
sterile procedure that requires nursing judgment and assessment skills. It should be performed by
licensed nursing staff (RN or LPN).
d. Asking a UAP to turn off the tube feeding for a client who is receiving continuous tube feedings and is
vomiting.
INCORRECT
Rationale: While a UAP can report vomiting, the decision to stop tube feedings requires nursing
assessment and judgment. The nurse needs to assess the client, determine the cause, and make clinical
decisions about the feeding regimen.
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. 2 years old, has impaired fine and gross motor skills, and was just diagnosed with cerebral palsy.
CORRECT ANSWER
Rationale: A new diagnosis of cerebral palsy requires comprehensive interdisciplinary planning involving
physical therapy, occupational therapy, speech therapy, social work, and possibly developmental
specialists to create a comprehensive care plan for this complex, chronic condition.
b. 7 months old, has intussusception, is vomiting, has colicky abdominal pain, and is having jelly like
stools.
INCORRECT
Rationale: This is an acute emergency requiring immediate medical intervention, not an interdisciplinary
conference. This client needs urgent diagnostic studies and likely surgical consultation immediately.
c. 6 months old, has respiratory syncytial virus (RSV), is wheezing, and has copious nasal discharge.
INCORRECT
Rationale: RSV with wheezing is a common pediatric respiratory condition that can be managed with
standard respiratory treatments and nursing care. It does not typically require interdisciplinary
conference unless complications arise.
, d. 2 months old, has developmental dysplasia of the hip, unequal leg lengths, limited abduction of the
left hip, and asymmetry of the gluteal folds.
INCORRECT
Rationale: While developmental dysplasia of the hip requires orthopedic follow-up and possibly physical
therapy, the initial management is typically straightforward (Pavlik harness) and does not necessarily
require a full interdisciplinary conference.
5. The nurse has been aware of the following client situations. It is necessary for the nurse to initially
assess the client who has:
a. Status asthmaticus, had wheezing on inspiration and expiration upon admission 30 minutes ago,
received a nebulizer treatment, and now has vesicular breath sounds.
INCORRECT
Rationale: This client is showing improvement. Vesicular breath sounds are normal breath sounds,
indicating the bronchospasm is resolving after treatment. This client is stable and not the priority.
b. Heart failure (CHF), received labetalol 2 hours ago, and has a pulse (P) rate that has decreased from
77 to 63 over the past hour.
INCORRECT
Rationale: A pulse of 63 bpm is within normal limits (60-100 bpm). This is an expected response to beta-
blocker therapy like labetalol. The client is stable and not the priority.
c. Emphysema, has an oxygen saturation (SaO2) level of 89%, and is using pursed lip breathing while
sitting up in a chair.
INCORRECT
Rationale: For clients with emphysema/COPD, an O2 saturation of 88-92% is often the target range to
prevent CO2 retention. The client is using appropriate breathing techniques and is in a position that
facilitates breathing. This is expected for this condition.
d. Coronary artery disease (CAD), is receiving a continuous heparin infusion, and has a partial
thromboplastin time of 90 seconds.
CORRECT ANSWER
Rationale: This is the priority. A PTT of 90 seconds is above the therapeutic range (usually 1.5-2.5 times
normal, approximately 46-70 seconds). This indicates excessive anticoagulation and high risk for
bleeding. The nurse must assess for bleeding and likely hold or decrease the heparin infusion.
6. The nurse is caring for a client who weighs 150 pounds (68 kg) and has developed hepatic
encephalopathy. It is a priority for the nurse to notify the primary healthcare provider if the client
develops:
a. An increase in urine output to 1,450 mL/day.
Complete Practice Exam with ANSWERs and
Rationales 2026
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 physical therapy referral for a client who had total knee replacement (TKR) and needs use of a
walker.
CORRECT ANSWER
Rationale: This is appropriate because physical therapy specializes in mobility training, gait training, and
teaching proper use of assistive devices like walkers after orthopedic surgeries such as total knee
replacement.
b. A speech therapy referral for a client who is scheduled to undergo an outpatient
esophagogastroduodenoscopy (EGD).
INCORRECT
Rationale: Speech therapy is not indicated for EGD procedures. Speech therapy addresses swallowing
disorders, speech impairments, and communication issues. An EGD is a diagnostic procedure that does
not typically require speech therapy involvement.
c. An occupational therapy (OT) referral for a client who had an amputation and requires long term IV
antibiotics.
INCORRECT
Rationale: Long-term IV antibiotics require home health nursing or infusion services, not occupational
therapy. OT focuses on activities of daily living (ADLs), adaptive equipment, and functional
independence, not medication administration.
d. A social worker referral for a client who has diabetes mellitus (type 2) and has developed neuropathy.
INCORRECT
Rationale: While social workers can help with diabetes management resources, neuropathy itself does
not automatically require social work involvement. This client would benefit more from diabetes
education, podiatry referral, or wound care if ulcers are present.
,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. "Threatening to touch a client without the client's consent is an example of battery."
INCORRECT
Rationale: Threatening to touch without consent is assault, not battery. Battery is the actual unwanted
touching or physical contact. Assault is the threat or attempt to cause harmful or offensive contact.
b. "Failure to communicate concerns of an older adult client who is confused and is being discharged
home is an example of negligence."
CORRECT ANSWER
Rationale: Negligence is the failure to act as a reasonably prudent nurse would in similar circumstances.
Failing to communicate important patient concerns that could affect patient safety constitutes
negligence and breach of the standard of care.
c. "Giving clients false assurance about a healthcare condition or expected outcome is an example of
libel."
INCORRECT
Rationale: False assurance is not libel. Libel is a false written statement that damages someone's
reputation. Giving false assurance may be considered unethical practice or potentially fraud, but it is not
libel.
d. "Posting information about a client on social media without the client's permission is an example of
slander."
INCORRECT
Rationale: Posting client information without permission is a HIPAA violation and breach of
confidentiality, not slander. Slander is spoken defamation. This action could also be considered libel if
written, but the primary issue is privacy violation.
3. The nurse working in a medical surgical unit is caring for assigned clients. Which of the following tests
is appropriate to delegate?
a. Asking a licensed practical nurse to teach a client who has a newly created ileostomy how to change
the appliance.
INCORRECT
Rationale: Teaching new ostomy care should not be delegated to an LPN. Initial teaching of complex
new procedures, especially those requiring comprehensive assessment and evaluation of learning,
should be performed by the RN. LPNs can reinforce teaching already provided by the RN.
b. Asking a licensed practical nurse to obtain a capillary blood glucose reading on a client who has
become diaphoretic.
,CORRECT ANSWER
Rationale: This is appropriate delegation. LPNs can perform routine, standardized procedures like blood
glucose monitoring. This is within their scope of practice and does not require the assessment and
judgment skills of an RN.
c. Asking a UAP to flush the closed wound drainage system of a client who is two days postoperative
from an open appendectomy.
INCORRECT
Rationale: UAPs (Unlicensed Assistive Personnel) should not flush wound drainage systems. This is a
sterile procedure that requires nursing judgment and assessment skills. It should be performed by
licensed nursing staff (RN or LPN).
d. Asking a UAP to turn off the tube feeding for a client who is receiving continuous tube feedings and is
vomiting.
INCORRECT
Rationale: While a UAP can report vomiting, the decision to stop tube feedings requires nursing
assessment and judgment. The nurse needs to assess the client, determine the cause, and make clinical
decisions about the feeding regimen.
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. 2 years old, has impaired fine and gross motor skills, and was just diagnosed with cerebral palsy.
CORRECT ANSWER
Rationale: A new diagnosis of cerebral palsy requires comprehensive interdisciplinary planning involving
physical therapy, occupational therapy, speech therapy, social work, and possibly developmental
specialists to create a comprehensive care plan for this complex, chronic condition.
b. 7 months old, has intussusception, is vomiting, has colicky abdominal pain, and is having jelly like
stools.
INCORRECT
Rationale: This is an acute emergency requiring immediate medical intervention, not an interdisciplinary
conference. This client needs urgent diagnostic studies and likely surgical consultation immediately.
c. 6 months old, has respiratory syncytial virus (RSV), is wheezing, and has copious nasal discharge.
INCORRECT
Rationale: RSV with wheezing is a common pediatric respiratory condition that can be managed with
standard respiratory treatments and nursing care. It does not typically require interdisciplinary
conference unless complications arise.
, d. 2 months old, has developmental dysplasia of the hip, unequal leg lengths, limited abduction of the
left hip, and asymmetry of the gluteal folds.
INCORRECT
Rationale: While developmental dysplasia of the hip requires orthopedic follow-up and possibly physical
therapy, the initial management is typically straightforward (Pavlik harness) and does not necessarily
require a full interdisciplinary conference.
5. The nurse has been aware of the following client situations. It is necessary for the nurse to initially
assess the client who has:
a. Status asthmaticus, had wheezing on inspiration and expiration upon admission 30 minutes ago,
received a nebulizer treatment, and now has vesicular breath sounds.
INCORRECT
Rationale: This client is showing improvement. Vesicular breath sounds are normal breath sounds,
indicating the bronchospasm is resolving after treatment. This client is stable and not the priority.
b. Heart failure (CHF), received labetalol 2 hours ago, and has a pulse (P) rate that has decreased from
77 to 63 over the past hour.
INCORRECT
Rationale: A pulse of 63 bpm is within normal limits (60-100 bpm). This is an expected response to beta-
blocker therapy like labetalol. The client is stable and not the priority.
c. Emphysema, has an oxygen saturation (SaO2) level of 89%, and is using pursed lip breathing while
sitting up in a chair.
INCORRECT
Rationale: For clients with emphysema/COPD, an O2 saturation of 88-92% is often the target range to
prevent CO2 retention. The client is using appropriate breathing techniques and is in a position that
facilitates breathing. This is expected for this condition.
d. Coronary artery disease (CAD), is receiving a continuous heparin infusion, and has a partial
thromboplastin time of 90 seconds.
CORRECT ANSWER
Rationale: This is the priority. A PTT of 90 seconds is above the therapeutic range (usually 1.5-2.5 times
normal, approximately 46-70 seconds). This indicates excessive anticoagulation and high risk for
bleeding. The nurse must assess for bleeding and likely hold or decrease the heparin infusion.
6. The nurse is caring for a client who weighs 150 pounds (68 kg) and has developed hepatic
encephalopathy. It is a priority for the nurse to notify the primary healthcare provider if the client
develops:
a. An increase in urine output to 1,450 mL/day.
