NSG 4100 Exam 3 Actual – 2026 Comprehensive Practice Exam
(2026)
Which patient should the charge nurse assess first?
A. Patient requesting pain medication — Rationale: Important but not immediately life-threatening.
B. Patient with stridor after extubation — Rationale: Correct; indicates possible airway obstruction.
C. Patient with blood glucose 180 mg/dL — Rationale: Elevated but not the highest priority.
D. Patient waiting for discharge teaching — Rationale: Stable and nonurgent.
ANSWER>.>: B
(2026) Which task is most appropriate to delegate to an experienced LPN?
A. Initial admission assessment — Rationale: RN responsibility; cannot be delegated.
B. Medication administration to a stable postoperative patient — Rationale: Correct; LPNs may
administer medications in many settings.
C. Care plan development — Rationale: Requires RN clinical judgment.
D. Blood transfusion initiation — Rationale: Usually requires RN assessment and monitoring.
ANSWER>.>: B
(2026) Which task may be safely assigned to unlicensed assistive personnel?
A. Assessing breath sounds — Rationale: Assessment cannot be delegated.
B. Obtaining vital signs on a stable patient — Rationale: Correct; routine data collection is appropriate.
C. Teaching insulin injection — Rationale: Teaching is RN responsibility.
D. Evaluating swallow function — Rationale: Requires licensed assessment.
ANSWER>.>: B
(2026) A nurse manager asks staff to vote on a new scheduling method. Which leadership style is
shown?
A. Autocratic — Rationale: Leader decides alone.
B. Democratic — Rationale: Correct; group participation is encouraged.
C. Laissez-faire — Rationale: Leader provides little direction.
D. Transactional — Rationale: Focuses on rewards and compliance.
ANSWER>.>: B
,(2026) Two nurses are arguing about assignment fairness. What is the best first action by the charge
nurse?
A. Ignore the conflict — Rationale: Conflict may escalate and affect care.
B. Facilitate a private discussion — Rationale: Correct; open communication clarifies concerns.
C. Change the assignment immediately — Rationale: Premature without assessment.
D. Report both nurses to HR — Rationale: Escalation is not first-line.
ANSWER>.>: B
(2026) A patient refuses chemotherapy despite provider recommendation. Which ethical principle
supports the refusal?
A. Beneficence — Rationale: Focuses on doing good.
B. Autonomy — Rationale: Correct; patients may make informed choices.
C. Justice — Rationale: Focuses on fairness.
D. Fidelity — Rationale: Focuses on keeping promises.
ANSWER>.>: B
(2026) A nurse witnesses a patient sign a surgical consent form. What is the nurse’s primary role?
A. Explain surgical risks — Rationale: Provider responsibility.
B. Confirm consent is voluntary and witnessed — Rationale: Correct; nurse often witnesses signature.
C. Decide if surgery is needed — Rationale: Not nursing scope.
D. Sign the consent for the patient — Rationale: Invalid and unethical.
ANSWER>.>: B
(2026) A nurse discusses a patient’s diagnosis in an elevator with visitors. What violation occurred?
A. Assault — Rationale: Threat of harm, not privacy issue.
B. HIPAA privacy violation — Rationale: Correct; protected information was disclosed publicly.
C. Battery — Rationale: Involves unlawful touching.
D. Defamation — Rationale: Involves false statements harming reputation.
ANSWER>.>: B
(2026) After a medication error, what is the nurse’s first action?
A. Complete an incident report — Rationale: Important after patient assessment.
B. Assess the patient — Rationale: Correct; safety and condition come first.
,C. Notify risk management — Rationale: Later step.
D. Document the error — Rationale: Important but after assessment.
ANSWER>.>: B
(2026) Which tool is used to test a small change before full implementation?
A. Root cause analysis — Rationale: Used after serious events.
B. PDSA cycle — Rationale: Correct; Plan-Do-Study-Act tests change.
C. Pareto chart — Rationale: Identifies frequent problems.
D. Fishbone diagram — Rationale: Shows causes, not testing.
ANSWER>.>: B
(2026) A patient falls and fractures a hip. How is this event classified?
A. Near miss — Rationale: No harm occurred in a near miss.
B. Sentinel event — Rationale: Correct; serious harm occurred.
C. Variance — Rationale: General deviation from expected outcome.
D. Benchmark — Rationale: Comparison standard, not event type.
ANSWER>.>: B
(2026) Which communication tool provides a structured handoff?
A. SWOT — Rationale: Strategic analysis tool.
B. SBAR — Rationale: Correct; Situation, Background, Assessment, Recommendation.
C. LEAN — Rationale: Process improvement method.
D. SMART — Rationale: Goal-setting format.
ANSWER>.>: B
(2026) A leader inspires staff by creating a shared vision for patient-centered care. Which style is this?
A. Transformational — Rationale: Correct; motivates through vision and change.
B. Autocratic — Rationale: Leader controls decisions.
C. Bureaucratic — Rationale: Rule-focused leadership.
D. Laissez-faire — Rationale: Minimal leader involvement.
ANSWER>.>: A
(2026) In Lewin’s change theory, preparing staff by explaining why change is needed occurs in which
phase?
, A. Refreezing — Rationale: Stabilizes change after implementation.
B. Moving — Rationale: Actual implementation phase.
C. Unfreezing — Rationale: Correct; creates readiness for change.
D. Evaluating — Rationale: Not one of Lewin’s three phases.
ANSWER>.>: C
(2026) Which principle must the RN use before delegating?
A. Assign all tasks to save time — Rationale: Unsafe and inappropriate.
B. Match task to patient condition and staff competence — Rationale: Correct; delegation requires safe
matching.
C. Delegate assessment if UAP is experienced — Rationale: Assessment cannot be delegated.
D. Avoid supervision once task is delegated — Rationale: Supervision remains necessary.
ANSWER>.>: B
(2026) Which patient should be seen first after shift report?
A. Stable patient with chest pain rated 2/10 — Rationale: Concerning but less acute than new severe
symptoms.
B. Patient with new confusion and oxygen saturation 88% — Rationale: Correct; possible hypoxia or
acute decline.
C. Patient needing discharge medications — Rationale: Important but stable.
D. Patient awaiting breakfast tray — Rationale: Nonurgent.
ANSWER>.>: B
(2026) A nurse realizes insulin was given at the wrong time. What is the priority?
A. Assess blood glucose and patient status — Rationale: Correct; immediate safety assessment.
B. Complete a variance report — Rationale: Important later.
C. Notify pharmacy — Rationale: Not first priority.
D. Apologize to the family — Rationale: Important but after assessment.
ANSWER>.>: A
(2026) What is the purpose of an incident report?
A. Punish staff — Rationale: Reports should improve safety, not blame.
B. Document patient injury and support quality review — Rationale: Correct; used for risk reduction.
C. Replace nursing notes — Rationale: Not a substitute for clinical documentation.
(2026)
Which patient should the charge nurse assess first?
A. Patient requesting pain medication — Rationale: Important but not immediately life-threatening.
B. Patient with stridor after extubation — Rationale: Correct; indicates possible airway obstruction.
C. Patient with blood glucose 180 mg/dL — Rationale: Elevated but not the highest priority.
D. Patient waiting for discharge teaching — Rationale: Stable and nonurgent.
ANSWER>.>: B
(2026) Which task is most appropriate to delegate to an experienced LPN?
A. Initial admission assessment — Rationale: RN responsibility; cannot be delegated.
B. Medication administration to a stable postoperative patient — Rationale: Correct; LPNs may
administer medications in many settings.
C. Care plan development — Rationale: Requires RN clinical judgment.
D. Blood transfusion initiation — Rationale: Usually requires RN assessment and monitoring.
ANSWER>.>: B
(2026) Which task may be safely assigned to unlicensed assistive personnel?
A. Assessing breath sounds — Rationale: Assessment cannot be delegated.
B. Obtaining vital signs on a stable patient — Rationale: Correct; routine data collection is appropriate.
C. Teaching insulin injection — Rationale: Teaching is RN responsibility.
D. Evaluating swallow function — Rationale: Requires licensed assessment.
ANSWER>.>: B
(2026) A nurse manager asks staff to vote on a new scheduling method. Which leadership style is
shown?
A. Autocratic — Rationale: Leader decides alone.
B. Democratic — Rationale: Correct; group participation is encouraged.
C. Laissez-faire — Rationale: Leader provides little direction.
D. Transactional — Rationale: Focuses on rewards and compliance.
ANSWER>.>: B
,(2026) Two nurses are arguing about assignment fairness. What is the best first action by the charge
nurse?
A. Ignore the conflict — Rationale: Conflict may escalate and affect care.
B. Facilitate a private discussion — Rationale: Correct; open communication clarifies concerns.
C. Change the assignment immediately — Rationale: Premature without assessment.
D. Report both nurses to HR — Rationale: Escalation is not first-line.
ANSWER>.>: B
(2026) A patient refuses chemotherapy despite provider recommendation. Which ethical principle
supports the refusal?
A. Beneficence — Rationale: Focuses on doing good.
B. Autonomy — Rationale: Correct; patients may make informed choices.
C. Justice — Rationale: Focuses on fairness.
D. Fidelity — Rationale: Focuses on keeping promises.
ANSWER>.>: B
(2026) A nurse witnesses a patient sign a surgical consent form. What is the nurse’s primary role?
A. Explain surgical risks — Rationale: Provider responsibility.
B. Confirm consent is voluntary and witnessed — Rationale: Correct; nurse often witnesses signature.
C. Decide if surgery is needed — Rationale: Not nursing scope.
D. Sign the consent for the patient — Rationale: Invalid and unethical.
ANSWER>.>: B
(2026) A nurse discusses a patient’s diagnosis in an elevator with visitors. What violation occurred?
A. Assault — Rationale: Threat of harm, not privacy issue.
B. HIPAA privacy violation — Rationale: Correct; protected information was disclosed publicly.
C. Battery — Rationale: Involves unlawful touching.
D. Defamation — Rationale: Involves false statements harming reputation.
ANSWER>.>: B
(2026) After a medication error, what is the nurse’s first action?
A. Complete an incident report — Rationale: Important after patient assessment.
B. Assess the patient — Rationale: Correct; safety and condition come first.
,C. Notify risk management — Rationale: Later step.
D. Document the error — Rationale: Important but after assessment.
ANSWER>.>: B
(2026) Which tool is used to test a small change before full implementation?
A. Root cause analysis — Rationale: Used after serious events.
B. PDSA cycle — Rationale: Correct; Plan-Do-Study-Act tests change.
C. Pareto chart — Rationale: Identifies frequent problems.
D. Fishbone diagram — Rationale: Shows causes, not testing.
ANSWER>.>: B
(2026) A patient falls and fractures a hip. How is this event classified?
A. Near miss — Rationale: No harm occurred in a near miss.
B. Sentinel event — Rationale: Correct; serious harm occurred.
C. Variance — Rationale: General deviation from expected outcome.
D. Benchmark — Rationale: Comparison standard, not event type.
ANSWER>.>: B
(2026) Which communication tool provides a structured handoff?
A. SWOT — Rationale: Strategic analysis tool.
B. SBAR — Rationale: Correct; Situation, Background, Assessment, Recommendation.
C. LEAN — Rationale: Process improvement method.
D. SMART — Rationale: Goal-setting format.
ANSWER>.>: B
(2026) A leader inspires staff by creating a shared vision for patient-centered care. Which style is this?
A. Transformational — Rationale: Correct; motivates through vision and change.
B. Autocratic — Rationale: Leader controls decisions.
C. Bureaucratic — Rationale: Rule-focused leadership.
D. Laissez-faire — Rationale: Minimal leader involvement.
ANSWER>.>: A
(2026) In Lewin’s change theory, preparing staff by explaining why change is needed occurs in which
phase?
, A. Refreezing — Rationale: Stabilizes change after implementation.
B. Moving — Rationale: Actual implementation phase.
C. Unfreezing — Rationale: Correct; creates readiness for change.
D. Evaluating — Rationale: Not one of Lewin’s three phases.
ANSWER>.>: C
(2026) Which principle must the RN use before delegating?
A. Assign all tasks to save time — Rationale: Unsafe and inappropriate.
B. Match task to patient condition and staff competence — Rationale: Correct; delegation requires safe
matching.
C. Delegate assessment if UAP is experienced — Rationale: Assessment cannot be delegated.
D. Avoid supervision once task is delegated — Rationale: Supervision remains necessary.
ANSWER>.>: B
(2026) Which patient should be seen first after shift report?
A. Stable patient with chest pain rated 2/10 — Rationale: Concerning but less acute than new severe
symptoms.
B. Patient with new confusion and oxygen saturation 88% — Rationale: Correct; possible hypoxia or
acute decline.
C. Patient needing discharge medications — Rationale: Important but stable.
D. Patient awaiting breakfast tray — Rationale: Nonurgent.
ANSWER>.>: B
(2026) A nurse realizes insulin was given at the wrong time. What is the priority?
A. Assess blood glucose and patient status — Rationale: Correct; immediate safety assessment.
B. Complete a variance report — Rationale: Important later.
C. Notify pharmacy — Rationale: Not first priority.
D. Apologize to the family — Rationale: Important but after assessment.
ANSWER>.>: A
(2026) What is the purpose of an incident report?
A. Punish staff — Rationale: Reports should improve safety, not blame.
B. Document patient injury and support quality review — Rationale: Correct; used for risk reduction.
C. Replace nursing notes — Rationale: Not a substitute for clinical documentation.
